How To Use CPT Code 43206

CPT 43206 describes the use of a flexible endoscope to evaluate the patient’s esophagus using an endomicroscopy system. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43206?

CPT 43206 is a code used to describe a procedure in which a flexible endoscope is inserted through the patient’s mouth to evaluate the esophagus. During this procedure, an endomicroscopy system is used to collect high-resolution images from a thin section within the tissue. It is important to note that the supply of contrast agent should be reported separately, and this code should not be reported in conjunction with codes 43197, 43198, 43200, or 88375.

2. Official Description

The official description of CPT code 43206 is: ‘Esophagoscopy, flexible, transoral; with optical endomicroscopy.’ It is important to remember to report the supply of contrast agent separately and not to report this code with codes 43197, 43198, 43200, or 88375.

3. Procedure

1. With the patient appropriately prepped and anesthetized, the healthcare provider inserts a flexible endoscope through the patient’s mouth and down the throat to the level of the esophagus.
2. Using an endomicroscopy system, the provider inspects the esophagus for any lesions or abnormalities.
3. The endomicroscopy system allows the provider to collect high-resolution images from a thin section within the tissue, providing detailed information about the patient’s esophageal condition.
4. Once the procedure is completed, the provider removes the flexible endoscope from the patient’s throat.

4. Qualifying circumstances

CPT 43206 is typically performed on patients who require an evaluation of their esophagus. This procedure is commonly used to assess the presence of lesions or abnormalities within the esophageal tissue. It is important to note that this code should not be reported with codes 43197, 43198, 43200, or 88375.

5. When to use CPT code 43206

CPT code 43206 should be used when a healthcare provider performs a flexible esophagoscopy with optical endomicroscopy to evaluate the patient’s esophagus. It is important to remember not to report this code with codes 43197, 43198, 43200, or 88375.

6. Documentation requirements

To support a claim for CPT code 43206, the healthcare provider must document the following information:

• Patient’s medical history and reason for the procedure
• Details of the procedure, including the use of a flexible endoscope and optical endomicroscopy
• Date and duration of the procedure
• Findings from the evaluation of the esophagus
• Any additional procedures or interventions performed during the same session
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 43206, ensure that the procedure meets the criteria described in the official description. It is important not to report this code with codes 43197, 43198, 43200, or 88375. Additionally, remember to report the supply of contrast agent separately if used during the procedure.

8. Historical information

CPT code 43206 was added to the Current Procedural Terminology system on January 1, 2013. It was previously known as ‘Esophagoscopy, rigid or flexible; with optical endomicroscopy’ before a code change on January 1, 2014. There have been no further updates to the code since its addition.

9. Examples

1. A gastroenterologist performs a flexible esophagoscopy with optical endomicroscopy to evaluate a patient with suspected esophageal lesions.
2. A patient with a history of Barrett’s esophagus undergoes a flexible esophagoscopy with optical endomicroscopy for surveillance purposes.
3. A healthcare provider performs a flexible esophagoscopy with optical endomicroscopy to assess the extent of esophageal inflammation in a patient with eosinophilic esophagitis.
4. A patient with dysphagia undergoes a flexible esophagoscopy with optical endomicroscopy to identify any structural abnormalities in the esophagus.
5. A gastroenterologist performs a flexible esophagoscopy with optical endomicroscopy to evaluate a patient with gastroesophageal reflux disease (GERD) who is not responding to medical treatment.
6. A patient with a history of esophageal cancer undergoes a flexible esophagoscopy with optical endomicroscopy for surveillance and detection of any recurrent lesions.
7. A healthcare provider performs a flexible esophagoscopy with optical endomicroscopy to evaluate a patient with suspected esophageal varices.
8. A patient with a history of esophageal strictures undergoes a flexible esophagoscopy with optical endomicroscopy to assess the severity of the strictures.
9. A gastroenterologist performs a flexible esophagoscopy with optical endomicroscopy to evaluate a patient with unexplained weight loss and gastrointestinal symptoms.
10. A patient with a history of esophageal surgery undergoes a flexible esophagoscopy with optical endomicroscopy for postoperative surveillance.