How To Use CPT Code 43211

CPT 43211 describes a specific procedure known as esophagoscopy with endoscopic mucosal resection. This article will provide an overview of CPT code 43211, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43211?

CPT 43211 is a code used to describe the procedure of esophagoscopy with endoscopic mucosal resection. This involves the insertion of a flexible endoscope through the patient’s mouth to access the esophagus. The provider then uses an instrument to remove or excise mucosal tissue from the esophageal lining. It is important to note that CPT 43211 should not be reported in conjunction with certain other codes for the same lesion.

2. Official Description

The official description of CPT code 43211 is: ‘Esophagoscopy, flexible, transoral; with endoscopic mucosal resection.’ It is important to follow the specific guidelines and notes associated with this code, such as not reporting it with certain other codes for the same lesion.

3. Procedure

1. With the patient appropriately prepped and anesthetized, the provider inserts a flexible endoscope through the patient’s mouth and down the throat to the level of the esophagus.
2. The provider then inspects the esophagus for any lesions or areas of damaged or diseased tissue.
3. If a lesion is identified, the provider performs a submucosal injection to elevate the lesion.
4. Using specialized instruments passed through the endoscope, the provider then resects or cuts out the lesion from the esophageal mucosa.
5. Once the procedure is completed, the provider removes the endoscope.

4. Qualifying circumstances

CPT 43211 is typically performed on patients who have lesions or well-defined areas of damaged or diseased tissue in the esophagus. The procedure requires the use of a flexible endoscope and specialized instruments. It is important to note that CPT 43211 should not be reported in conjunction with certain other codes for the same lesion.

5. When to use CPT code 43211

CPT code 43211 should be used when a provider performs esophagoscopy with endoscopic mucosal resection. It is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, it is crucial to follow any notes or guidelines associated with the code, such as not reporting it with certain other codes for the same lesion.

6. Documentation requirements

To support a claim for CPT code 43211, the provider must document the following information:

• Patient’s diagnosis and the need for the procedure
• Details of the procedure, including the use of a flexible endoscope and any specialized instruments
• Date and duration of the procedure
• Description of the lesion or area of tissue resected
• Any additional relevant information or findings
• Provider’s signature

7. Billing guidelines

When billing for CPT code 43211, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, it should not be reported in conjunction with certain other codes for the same lesion. It is recommended to review the specific billing guidelines and any associated modifiers to accurately report and receive reimbursement for this procedure.

8. Historical information

CPT code 43211 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates or changes to the code since its addition.

9. Examples

1. A gastroenterologist performing esophagoscopy with endoscopic mucosal resection to remove a lesion in a patient’s esophagus.
2. An otolaryngologist using CPT code 43211 to document the removal of a well-defined area of damaged tissue in a patient’s esophagus.
3. A general surgeon performing esophagoscopy with endoscopic mucosal resection to excise a lesion found during a diagnostic procedure.
4. A gastroenterologist using CPT code 43211 to report the removal of a lesion in the esophagus of a patient with a history of esophageal disease.
5. An interventional radiologist performing esophagoscopy with endoscopic mucosal resection to remove a lesion in a patient’s esophagus under fluoroscopic guidance.
6. A thoracic surgeon using CPT code 43211 to document the resection of a well-defined area of damaged tissue in a patient’s esophagus during a surgical procedure.
7. An oncologist performing esophagoscopy with endoscopic mucosal resection to remove a lesion in a patient’s esophagus as part of their cancer treatment plan.
8. A gastroenterologist using CPT code 43211 to report the removal of a lesion in the esophagus of a patient with a history of Barrett’s esophagus.
9. An otolaryngologist performing esophagoscopy with endoscopic mucosal resection to remove a lesion in a patient’s esophagus as part of their treatment for gastroesophageal reflux disease.
10. A general surgeon using CPT code 43211 to document the resection of a well-defined area of damaged tissue in a patient’s esophagus during a surgical procedure to repair a hiatal hernia.