How To Use CPT Code 43205

CPT 43205 describes the procedure of esophagoscopy with band ligation 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 43205?

CPT 43205 is used to describe the procedure of esophagoscopy with band ligation of esophageal varices. It involves the insertion of a flexible endoscope through the mouth to examine and treat abnormal blood vessels in the lower part of the esophagus. During the procedure, small elastic O-shaped rubber bands are placed around the bases of the varices, causing them to thrombose and the walls to stick together.

2. Official Description

The official description of CPT code 43205 is: ‘Esophagoscopy, flexible, transoral; with band ligation of esophageal varices.’

3. Procedure

1. The provider inserts a flexible endoscope into the patient’s mouth and passes it down the throat and into the esophagus.
2. The provider inspects the esophagus for esophageal varices, which are dilated blood vessels prone to bleeding.
3. Small elastic O-shaped rubber bands or bands are placed around the bases of the varices.
4. The bands cause the varices to thrombose and the walls to stick together.

4. Qualifying circumstances

CPT 43205 is performed on patients with esophageal varices, which are dilated blood vessels in the lower part of the esophagus. The procedure is typically performed by a provider who is trained in esophagoscopy and band ligation techniques. It is important to note that CPT 43205 should not be reported in conjunction with other codes for the same lesion or for control of nonvariceal bleeding with band ligation.

5. When to use CPT code 43205

CPT code 43205 should be used when a provider performs esophagoscopy with band ligation of esophageal varices. It is appropriate to use this code when the procedure is performed transorally using a flexible endoscope. If the procedure is performed using a rigid endoscope, a different code should be used.

6. Documentation requirements

To support a claim for CPT 43205, the provider must document the following information:

• Patient’s diagnosis of esophageal varices
• Description of the procedure performed, including the use of a flexible endoscope and band ligation
• Date of the procedure
• Any complications or additional interventions performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43205, ensure that the procedure is performed using a flexible endoscope and that band ligation of esophageal varices is documented. It is important to follow the guidelines and not report CPT 43205 in conjunction with other codes for the same lesion or for control of nonvariceal bleeding with band ligation. Additional tips for reporting CPT 43205 may include considering the location of the testing and the use of modifiers if necessary.

8. Historical information

CPT 43205 was added to the Current Procedural Terminology system on January 1, 1994. There was a code change on January 1, 2014, where the description was updated to specify flexible esophagoscopy.

9. Examples

1. A gastroenterologist performing esophagoscopy with band ligation of esophageal varices for a patient with cirrhosis.
2. An interventional radiologist using a flexible endoscope to perform band ligation of esophageal varices for a patient with portal hypertension.
3. A general surgeon performing esophagoscopy with band ligation of esophageal varices for a patient with a history of gastrointestinal bleeding.
4. An oncologist performing band ligation of esophageal varices using a flexible endoscope for a patient with esophageal cancer.
5. A gastroenterologist performing esophagoscopy with band ligation of esophageal varices for a patient with a history of alcohol abuse.
6. An interventional radiologist using a flexible endoscope to perform band ligation of esophageal varices for a patient with liver cirrhosis.
7. A general surgeon performing esophagoscopy with band ligation of esophageal varices for a patient with a history of hepatitis C.
8. An oncologist performing band ligation of esophageal varices using a flexible endoscope for a patient with metastatic liver cancer.
9. A gastroenterologist performing esophagoscopy with band ligation of esophageal varices for a patient with a history of portal vein thrombosis.
10. An interventional radiologist using a flexible endoscope to perform band ligation of esophageal varices for a patient with alcoholic liver disease.