How To Use CPT Code 43202

CPT 43202 describes the procedure of esophagoscopy, which involves the insertion of a flexible endoscope through the mouth to examine and treat abnormalities in the upper gastrointestinal tract. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43202?

CPT 43202 is used to describe the procedure of esophagoscopy, which involves the insertion of a flexible endoscope through the mouth to examine and treat abnormalities in the upper gastrointestinal tract. This code specifically includes the biopsy of single or multiple tissue samples during the procedure. It is important to note that CPT 43202 should not be reported in conjunction with CPT 43211 for the same lesion, or with CPT codes 43197, 43198, or 43200. For rigid transoral esophagoscopy with biopsy, CPT code 43193 should be used, and for flexible transnasal esophagoscopy with biopsy, CPT code 43198 should be used.

2. Official Description

The official description of CPT code 43202 is: ‘Esophagoscopy, flexible, transoral; with biopsy, single or multiple.’

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The healthcare provider inserts a flexible endoscope through the patient’s mouth, down the throat, and into the esophagus.
3. The provider carefully inspects the esophagus for any abnormalities or lesions.
4. If any suspicious tissue is identified, the provider uses biopsy forceps to remove one or more tissue samples for further examination.
5. The provider may perform additional biopsies if necessary.

4. Qualifying circumstances

CPT 43202 is typically performed on patients who require an examination and potential treatment of abnormalities in the upper gastrointestinal tract. The procedure is commonly used to diagnose conditions such as esophageal cancer, Barrett’s esophagus, esophagitis, and other esophageal disorders. It is important to note that CPT 43202 should not be reported in conjunction with CPT 43211 for the same lesion, or with CPT codes 43197, 43198, or 43200.

5. When to use CPT code 43202

CPT code 43202 should be used when a healthcare provider performs a flexible transoral esophagoscopy with biopsy, involving the insertion of a flexible endoscope through the patient’s mouth to examine and treat abnormalities in the upper gastrointestinal tract. This code specifically includes the biopsy of single or multiple tissue samples during the procedure. It is important to follow the guidelines and not report CPT 43202 in conjunction with other specific codes for the same lesion or different procedures.

6. Documentation requirements

To support a claim for CPT 43202, the healthcare provider must document the following information:

• Patient’s diagnosis or reason for the procedure
• Details of the procedure, including the use of a flexible endoscope and the biopsy of single or multiple tissue samples
• Date of the procedure
• Any abnormalities or lesions identified during the procedure
• Number of tissue samples obtained
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43202, ensure that the procedure performed is a flexible transoral esophagoscopy with biopsy. It is important to follow the guidelines and not report CPT 43202 in conjunction with other specific codes for the same lesion or different procedures. If an endoscopic biopsy is performed on the same day as the excision or removal of a lesion or tumor in the same area, it should not be reported separately, as it is included in the more extensive procedure code. However, if the biopsy is performed in a separate area and unrelated to the excision, it may be reported with modifier 59 as a distinct procedure service, provided that the documentation justifies it as separate and distinct.

8. Historical information

CPT 43202 was added to the Current Procedural Terminology system on January 1, 1990. It was later changed on January 1, 2014, to specify that it includes the biopsy of single or multiple tissue samples.

9. Examples

1. A gastroenterologist performing a flexible transoral esophagoscopy with biopsy to evaluate a patient with suspected esophageal cancer.
2. An otolaryngologist conducting a flexible transoral esophagoscopy with biopsy to assess a patient with symptoms of Barrett’s esophagus.
3. A general surgeon performing a flexible transoral esophagoscopy with biopsy to investigate a patient with chronic esophagitis.
4. An oncologist conducting a flexible transoral esophagoscopy with biopsy to diagnose a patient with suspected esophageal dysplasia.
5. A gastroenterologist performing a flexible transoral esophagoscopy with biopsy to evaluate a patient with suspected eosinophilic esophagitis.
6. An otolaryngologist conducting a flexible transoral esophagoscopy with biopsy to assess a patient with symptoms of gastroesophageal reflux disease (GERD).
7. A general surgeon performing a flexible transoral esophagoscopy with biopsy to investigate a patient with suspected esophageal stricture.
8. An oncologist conducting a flexible transoral esophagoscopy with biopsy to diagnose a patient with suspected esophageal varices.
9. A gastroenterologist performing a flexible transoral esophagoscopy with biopsy to evaluate a patient with suspected esophageal diverticulum.
10. An otolaryngologist conducting a flexible transoral esophagoscopy with biopsy to assess a patient with symptoms of achalasia.