How To Use CPT Code 43214

CPT 43214 describes the procedure of esophagoscopy with dilation of the esophagus using a balloon with a diameter of 30 mm or larger. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43214?

CPT 43214 can be used to describe the procedure of esophagoscopy with dilation of the esophagus using a balloon with a diameter of 30 mm or larger. This code is used when a healthcare provider inserts a flexible endoscope through the mouth and uses a balloon to dilate the esophagus. The procedure may include fluoroscopic guidance, which is included in the code and cannot be reported separately.

2. Official Description

The official description of CPT code 43214 is: ‘Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed).’ This code should not be reported in conjunction with codes 43197, 43198, 43200, 74360, or 76000.

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. A flexible endoscope is inserted through the patient’s mouth, down the throat, and into the esophagus.
3. The healthcare provider inspects the esophagus and identifies any strictures or narrowings.
4. A balloon dilator with a diameter of 30 mm or larger is inserted through the endoscope and positioned at the site of the stricture.
5. The balloon is inflated, increasing the diameter of the esophagus and dilating the stricture.
6. Once the desired amount of dilation is achieved, the balloon dilator is removed.
7. Fluoroscopic guidance may be used during the procedure to visualize the esophagus.
8. After the procedure is completed, the endoscope is removed.

4. Qualifying circumstances

CPT 43214 is performed on patients with strictures or narrowings in the esophagus that require dilation. The procedure is typically performed by a healthcare provider who is experienced in performing esophagoscopy. The use of a balloon dilator with a diameter of 30 mm or larger is necessary to achieve the desired dilation. Fluoroscopic guidance may be used during the procedure to assist the healthcare provider.

5. When to use CPT code 43214

CPT code 43214 should be used when a healthcare provider performs esophagoscopy with dilation of the esophagus using a balloon with a diameter of 30 mm or larger. This code should not be used for procedures involving smaller balloon dilators or for other types of esophagoscopy procedures.

6. Documentation requirements

To support a claim for CPT 43214, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the esophagoscopy with dilation
• Use of a balloon dilator with a diameter of 30 mm or larger
• Fluoroscopic guidance, if used
• Date of the procedure
• Start and end time of the procedure
• Any complications or adverse events that occurred during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43214, ensure that the procedure meets the criteria specified in the code description. Do not report CPT 43214 in conjunction with codes 43197, 43198, 43200, 74360, or 76000. If fluoroscopic guidance is used during the procedure, it should not be reported separately.

8. Historical information

CPT 43214 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 esophagoscopy with dilation using a balloon with a diameter of 30 mm to treat a patient with esophageal stricture.
2. During the procedure, the healthcare provider uses fluoroscopic guidance to assist in visualizing the esophagus and positioning the balloon dilator.
3. A patient with difficulty swallowing undergoes esophagoscopy with dilation using a balloon with a diameter of 30 mm to alleviate the narrowing in the esophagus.
4. A healthcare provider performs esophagoscopy with dilation using a balloon with a diameter of 30 mm to treat a patient with a benign esophageal stricture.
5. During the procedure, the healthcare provider carefully monitors the patient’s vital signs and ensures the safe and effective dilation of the esophagus.
6. An elderly patient with a history of esophageal strictures undergoes esophagoscopy with dilation using a balloon with a diameter of 30 mm to improve swallowing function.
7. The healthcare provider documents the details of the procedure, including the patient’s response to the dilation and any complications that may have occurred.
8. A patient with a history of gastroesophageal reflux disease (GERD) undergoes esophagoscopy with dilation using a balloon with a diameter of 30 mm to address esophageal narrowing.
9. The healthcare provider discusses the risks and benefits of the procedure with the patient and obtains informed consent prior to performing the dilation.
10. After the procedure, the healthcare provider provides post-procedure instructions to the patient and schedules a follow-up appointment to monitor the patient’s progress.