How To Use CPT Code 43204

CPT 43204 describes the procedure of esophagoscopy with injection sclerosis of esophageal varices. 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 43204?

CPT 43204 is used to describe the procedure of esophagoscopy with injection sclerosis of esophageal varices. This code is used when a healthcare provider inserts a flexible endoscope through the patient’s mouth and injects a sclerosing solution to treat enlarged blood vessels in the esophagus. It is important to note that CPT 43204 should not be reported in conjunction with other specific codes, as mentioned in the notes.

2. Official Description

The official description of CPT code 43204 is: ‘Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices.’ It is important to note the specific instructions mentioned in the notes, such as not reporting this code with other specific codes and using a different code for rigid transoral esophagoscopy with injection sclerosis of esophageal varices.

3. Procedure

1. The healthcare provider prepares the patient and administers anesthesia.
2. Using a flexible endoscope, the provider inserts the scope through the patient’s mouth, down the throat, and into the esophagus.
3. The provider visually inspects the esophagus for esophageal varices, which are dilated blood vessels prone to bleeding.
4. A sclerosant agent is injected into the submucosa surrounding the varices.
5. The injection of the sclerosant agent causes thrombosis (blood clotting) and damage to the intima (lining) of the varices, leading to the walls sticking together.

4. Qualifying circumstances

CPT 43204 is performed on patients with esophageal varices, which are dilated blood vessels within the walls of the lower part of the esophagus. These patients are at risk of bleeding and require treatment to address the varices. The procedure is performed by a healthcare provider using a flexible endoscope and a sclerosant agent to treat the varices.

5. When to use CPT code 43204

CPT code 43204 should be used when a healthcare provider performs esophagoscopy with injection sclerosis of esophageal varices using a flexible endoscope. It is important to follow the specific instructions mentioned in the notes and not report this code in conjunction with other specific codes.

6. Documentation requirements

To support a claim for CPT 43204, the healthcare provider must document the following information:

• Patient’s diagnosis of esophageal varices
• Details of the procedure, including the use of a flexible endoscope and injection of a sclerosant agent
• Date and time of the procedure
• Any complications or additional interventions performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43204, ensure that the procedure is performed using a flexible endoscope and involves the injection sclerosis of esophageal varices. Follow the specific instructions mentioned in the notes regarding reporting this code with other specific codes. It is important to accurately document and code the procedure to ensure appropriate reimbursement.

8. Historical information

CPT 43204 was added to the Current Procedural Terminology system on January 1, 1990. There have been historical changes to the code, including a code change on January 1, 2014, which resulted in the current description of the procedure.

9. Examples

1. A gastroenterologist performing esophagoscopy with injection sclerosis of esophageal varices for a patient with bleeding varices.
2. An interventional radiologist using a flexible endoscope to inject a sclerosant agent into esophageal varices to treat a patient with liver cirrhosis.
3. A general surgeon performing esophagoscopy with injection sclerosis of esophageal varices for a patient with a history of esophageal variceal bleeding.
4. An oncologist using a flexible endoscope to treat esophageal varices with injection sclerosis in a patient undergoing chemotherapy.
5. A gastroenterologist performing esophagoscopy with injection sclerosis of esophageal varices for a patient with portal hypertension.
6. An interventional radiologist using a flexible endoscope to inject a sclerosant agent into esophageal varices to prevent future bleeding in a patient with alcoholic liver disease.
7. A general surgeon performing esophagoscopy with injection sclerosis of esophageal varices for a patient with a history of alcohol abuse.
8. An oncologist using a flexible endoscope to treat esophageal varices with injection sclerosis in a patient with metastatic liver cancer.
9. A gastroenterologist performing esophagoscopy with injection sclerosis of esophageal varices for a patient with a history of esophageal variceal bleeding.
10. An interventional radiologist using a flexible endoscope to inject a sclerosant agent into esophageal varices to treat a patient with portal vein thrombosis.