How To Use CPT Code 43213

CPT 43213 describes a specific procedure involving the use of a flexible endoscope to view and dilate 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 43213?

CPT 43213 is a code used to describe a procedure in which a healthcare provider uses a flexible endoscope to examine and dilate the esophagus. This procedure is performed through the mouth and involves the insertion of a balloon or dilator to widen a stricture or narrowing of the esophagus. Fluoroscopic guidance may be used during the procedure. It is important to note that this code should not be reported in conjunction with certain other codes, as specified in the notes.

2. Official Description

The official description of CPT code 43213 is: ‘Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed).’ The notes associated with this code provide additional information on when and how to report it.

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. Using a flexible endoscope, the provider inserts the scope through the patient’s mouth and down into the esophagus.
3. Simultaneously, another scope is inserted through an opening, such as a gastrostomy, and maneuvered to the strictured area in the esophagus.
4. A guidewire is then maneuvered through the strictured area and grasped with a tool inserted through the esophagoscope.
5. The guidewire is pulled up until it exits the patient’s mouth, while the scope inserted through the gastrostomy is removed.
6. A balloon or dilator is then introduced over the guidewire, and fluoroscopy or endoscopic guidance may be used if necessary.
7. If a balloon is used, it is inflated to dilate the strictured area to a specified amount, and then deflated and removed.
8. If dilators are used, a series of dilators in increasing sizes are introduced to overcome the stricture.
9. The provider performs a final endoscopic check to ensure the success of the procedure.
10. Any fluoroscopy used for guidance is included in the code.
11. Once the procedure is completed, the provider removes the scope and guidewire, examining relevant anatomical features during removal.

4. Qualifying circumstances

CPT 43213 is typically performed on patients with strictures or narrowings in the esophagus that require dilation. The procedure is retrograde, meaning it is performed against the usual flow. It is important to note that this code should not be reported in conjunction with certain other codes, as specified in the notes.

5. When to use CPT code 43213

CPT code 43213 should be used when a healthcare provider performs a flexible esophagoscopy with dilation of the esophagus using a balloon or dilator. This code should not be reported with certain other codes, as specified in the notes. It is important to review the documentation and guidelines to ensure accurate reporting.

6. Documentation requirements

To support a claim for CPT 43213, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the procedure
• Specific details of the procedure, including the use of a balloon or dilator
• Fluoroscopic guidance, if performed
• Date and duration of the procedure
• Any additional relevant information or findings

7. Billing guidelines

When billing for CPT 43213, it is important to ensure that the procedure meets the criteria outlined in the official description. The use of fluoroscopic guidance, if performed, should not be billed separately. Additionally, this code should not be reported in conjunction with certain other codes, as specified in the notes. It is important to review the documentation and guidelines to ensure accurate reporting.

8. Historical information

CPT 43213 was added to the Current Procedural Terminology system on January 1, 2014. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider performs a flexible esophagoscopy with dilation of the esophagus using a balloon to treat a patient with esophageal stricture.
2. During a procedure, a healthcare provider uses a dilator to widen a narrowing in the esophagus of a patient with dysphagia.
3. A patient with a history of esophageal strictures undergoes a flexible esophagoscopy with dilation using a balloon to alleviate symptoms.
4. A healthcare provider performs a retrograde esophagoscopy with dilation using a dilator to treat a patient with achalasia.
5. During a procedure, a healthcare provider uses a balloon to dilate a stricture in the esophagus of a patient with eosinophilic esophagitis.
6. A patient with a history of esophageal strictures undergoes a flexible esophagoscopy with dilation using a dilator to improve swallowing function.
7. A healthcare provider performs a retrograde esophagoscopy with dilation using a balloon to treat a patient with corrosive esophagitis.
8. During a procedure, a healthcare provider uses a dilator to widen a narrowing in the esophagus of a patient with Barrett’s esophagus.
9. A patient with a history of esophageal strictures undergoes a flexible esophagoscopy with dilation using a balloon to relieve dysphagia symptoms.