How To Use CPT Code 43201

CPT code 43201 describes a specific procedure known as esophagoscopy with directed submucosal injection(s) using a flexible endoscope. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43201?

CPT 43201 is a code used to describe a procedure called esophagoscopy with directed submucosal injection(s) using a flexible endoscope. This procedure involves the insertion of a flexible endoscope through the mouth and into the esophagus. The provider then performs one or more injections into the submucosa, which is the tissue below the mucous membrane.

2. Official Description

The official description of CPT code 43201 is: ‘Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance.’ It is important to note that this code should not be reported in conjunction with certain other codes for the same lesion, as specified in the notes.

3. Procedure

1. The provider begins by appropriately prepping and anesthetizing the patient.
2. Using a flexible endoscope, the provider inserts it through the patient’s mouth and maneuvers it into the esophagus.
3. The provider then inspects the area using the endoscope and performs one or more submucosal injections into the tissue below the mucous membrane.
4. These injections may involve various substances, such as botulinum toxin, steroids, India ink, or saline, depending on the specific purpose of the procedure.
5. After completing the injections, the provider removes all instruments.

4. Qualifying circumstances

CPT 43201 is typically performed on patients who require submucosal injections for diagnostic or therapeutic purposes. The procedure is commonly used to treat certain muscular and nerve conditions, remove lesions, or facilitate the removal of lesions. It is important to note that this code should not be used for injection sclerosis of esophageal varices.

5. When to use CPT code 43201

CPT code 43201 should be used when a provider performs esophagoscopy with directed submucosal injection(s) using a flexible endoscope. It is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, it is crucial to review payer and coding guidelines to determine if certain services described by this code may be included in other codes when reported for the same lesion.

6. Documentation requirements

To support a claim for CPT 43201, the provider must document the following information:

• Patient’s diagnosis and the need for the procedure
• Details of the specific submucosal injections performed, including the substances used
• Date and duration of the procedure
• Any additional relevant information, such as the purpose of the injections or any complications encountered
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43201, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should also review payer and coding guidelines to determine if any additional documentation or modifiers are required. It is crucial to avoid reporting CPT 43201 in conjunction with certain other codes for the same lesion, as specified in the notes.

8. Historical information

CPT 43201 was added to the Current Procedural Terminology system on January 1, 2003. There was a code change on January 1, 2014, which resulted in the current description of the procedure.

9. Examples

1. A provider performs esophagoscopy with directed submucosal injection(s) using a flexible endoscope to treat a patient with a muscular condition.
2. During the procedure, the provider performs submucosal injections of botulinum toxin to temporarily paralyze facial muscles for cosmetic purposes.
3. A patient undergoes esophagoscopy with directed submucosal injection(s) using a flexible endoscope to mark a lesion with India ink for surgical removal.
4. A provider performs submucosal injections of steroids during esophagoscopy to treat inflammation in a patient’s esophagus.
5. Using a flexible endoscope, a provider performs submucosal injections of saline to lift a lesion for easier removal during esophagoscopy.
6. A patient undergoes esophagoscopy with directed submucosal injection(s) using a flexible endoscope to treat a nerve condition by preventing nerves from sending or receiving stimuli.
7. A provider performs submucosal injections of a specific substance to remove a lesion during esophagoscopy.
8. During the procedure, the provider performs submucosal injections of saline to facilitate the removal of a lesion in the patient’s esophagus.
9. A patient undergoes esophagoscopy with directed submucosal injection(s) using a flexible endoscope to treat a condition that requires the injection of a specific substance.
10. A provider performs submucosal injections of a substance to treat a patient’s esophageal condition during esophagoscopy.