How To Use CPT Code 43216

CPT 43216 describes the procedure of esophagoscopy with the removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps. 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 43216?

CPT 43216 is used to describe the procedure of esophagoscopy with the removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps. This code is specifically used when the provider examines the esophagus using a flexible esophagoscope and removes abnormal masses or growths using an instrument that grasps, excises, and cauterizes them. The procedure is performed transorally, through the mouth.

2. Official Description

The official description of CPT code 43216 is: ‘Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.’

3. Procedure

1. The provider inserts a flexible esophagoscope into the patient’s mouth and down the throat to the level of the esophagus.
2. Using the esophagoscope, the provider inspects the esophagus for any abnormal masses or growths.
3. If any lesions are found, the provider uses hot biopsy forceps to grasp and excise them.
4. During the excision, the hot biopsy forceps administer electrical current to cauterize the tissues and prevent bleeding.
5. The excised specimens are sent to a laboratory for analysis.
6. Once the procedure is complete, the provider removes all instruments and withdraws the esophagoscope.

4. Qualifying circumstances

CPT 43216 is performed on patients who require the removal of tumor(s), polyp(s), or other lesion(s) in the esophagus. The procedure is typically done when the patient has abnormal growths or masses that need to be excised for further analysis. The use of hot biopsy forceps allows for simultaneous biopsy and excision of these abnormal tissues. The procedure is performed by a provider using a flexible esophagoscope.

5. When to use CPT code 43216

CPT code 43216 should be used when a provider performs esophagoscopy with the removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps. It is important to note that this code should not be reported in conjunction with codes 43197, 43198, or 43200.

6. Documentation requirements

To support a claim for CPT 43216, the provider must document the following information:

• Patient’s diagnosis necessitating the procedure
• Specific details of the procedure performed, including the use of hot biopsy forceps
• Date of the procedure
• Any abnormal masses or growths identified and removed
• Details of the excised specimens and their submission to a laboratory for analysis

7. Billing guidelines

When billing for CPT 43216, ensure that the procedure meets the criteria described in the official description. It is important to note that this code should not be reported in conjunction with codes 43197, 43198, or 43200. If an endoscopic biopsy (CPT code 43202) is performed on the same day as the excision or removal of a lesion or tumor in the same area, it should not be reported separately, as it is included in the more extensive procedure code. However, if the biopsy is performed in a separate area and unrelated to the excision, it may be reported with modifier 59 as a distinct procedure service, provided that the documentation justifies it as separate and distinct.

8. Historical information

CPT 43216 was added to the Current Procedural Terminology system on January 1, 1994. Since then, there have been two code changes. On January 1, 2014, the code description was updated to include both flexible and rigid esophagoscopy. On January 1, 2015, the code description was further revised to include the use of bipolar cautery in addition to hot biopsy forceps.

9. Examples

1. A provider performs esophagoscopy with the removal of a tumor using hot biopsy forceps.
2. During an esophagoscopy procedure, a provider identifies and removes multiple polyps using hot biopsy forceps.
3. A patient undergoes esophagoscopy with the removal of a lesion in the esophagus using hot biopsy forceps.
4. A provider performs esophagoscopy with the removal of a tumor and a polyp using hot biopsy forceps.
5. During an esophagoscopy procedure, a provider identifies and removes a large lesion in the esophagus using hot biopsy forceps.
6. A patient undergoes esophagoscopy with the removal of multiple polyps and a tumor using hot biopsy forceps.
7. A provider performs esophagoscopy with the removal of a tumor and multiple lesions using hot biopsy forceps.
8. During an esophagoscopy procedure, a provider identifies and removes a tumor and several polyps using hot biopsy forceps.
9. A patient undergoes esophagoscopy with the removal of a lesion and multiple polyps in the esophagus using hot biopsy forceps.
10. A provider performs esophagoscopy with the removal of a tumor, a polyp, and several lesions using hot biopsy forceps.