How To Use CPT Code 43212

CPT 43212 describes a specific procedure used to treat narrowing in the esophagus. 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 43212?

CPT 43212 is a code used to describe a procedure that involves the insertion of a flexible endoscope through the mouth to the esophagus. During this procedure, an endoscopic stent is placed to treat narrowing in the esophagus. It includes pre- and post-dilation, as well as guide wire passage if necessary.

2. Official Description

The official description of CPT code 43212 is: ‘Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed).’ It is important to note that this code should not be reported in conjunction with certain other codes, such as 43197, 43198, 43200, 43220, 43226, and 43241. If fluoroscopic guidance is used during the procedure, code 74360 should be reported.

3. Procedure

1. The procedure begins with the administration of anesthesia to the patient.
2. The healthcare provider inserts a flexible endoscope through the patient’s mouth and down the throat to the level of the esophagus.
3. If there are any strictures or narrow areas in the esophagus, the provider uses guidewires and dilators to overcome them.
4. Once the dilation is complete, the provider passes an endoscopic stent to prevent the dilated area from collapsing.
5. After the stent placement, the provider removes the endoscope, completing the procedure.

4. Qualifying circumstances

CPT 43212 is typically performed on patients who have narrowing in their esophagus that requires treatment. This procedure is suitable for patients with conditions such as esophageal strictures or tumors. It is important to note that this procedure should be performed by a qualified healthcare provider who is experienced in performing esophagoscopy procedures.

5. When to use CPT code 43212

CPT code 43212 should be used when a flexible endoscope is inserted through the mouth to the esophagus to place an endoscopic stent. This code is appropriate when the procedure includes pre- and post-dilation, as well as guide wire passage if necessary. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 43212, the healthcare provider must document the following information:

• Patient’s diagnosis and the medical necessity for the procedure
• Details of the procedure, including the use of a flexible endoscope, pre- and post-dilation, and guide wire passage if performed
• Date and duration of the procedure
• Any complications or additional interventions during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 43212, it is important to ensure that the procedure meets the specific criteria outlined in the code description. This code should not be reported in conjunction with certain other codes, as mentioned earlier. If fluoroscopic guidance is used during the procedure, code 74360 should be reported separately. It is important to follow the guidelines provided by the payer and ensure accurate documentation to support the billing of this procedure.

8. Historical information

CPT code 43212 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 patient with an esophageal stricture undergoes a flexible esophagoscopy procedure with the placement of an endoscopic stent.
2. A healthcare provider performs a transoral esophagoscopy on a patient with an esophageal tumor and places an endoscopic stent to alleviate the narrowing.
3. A patient with a history of esophageal strictures undergoes a flexible esophagoscopy procedure with pre- and post-dilation and the placement of an endoscopic stent.
4. A healthcare provider performs a transoral esophagoscopy on a patient with an esophageal stricture and uses guidewires and dilators to overcome the narrowing before placing an endoscopic stent.
5. A patient with an esophageal tumor undergoes a flexible esophagoscopy procedure with the placement of an endoscopic stent to prevent the collapse of the dilated area.
6. A healthcare provider performs a transoral esophagoscopy on a patient with an esophageal stricture and places an endoscopic stent to maintain the patency of the esophagus.
7. A patient with a history of esophageal strictures undergoes a flexible esophagoscopy procedure with pre- and post-dilation and the placement of an endoscopic stent to alleviate the narrowing.
8. A healthcare provider performs a transoral esophagoscopy on a patient with an esophageal tumor and uses guidewires and dilators to overcome the narrowing before placing an endoscopic stent to maintain the patency of the esophagus.
9. A patient with an esophageal stricture undergoes a flexible esophagoscopy procedure with the placement of an endoscopic stent to prevent the collapse of the dilated area.