How To Use CPT Code 43220

CPT 43220 describes the procedure of esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter). This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43220?

CPT 43220 is used to describe a specific procedure called esophagoscopy with transendoscopic balloon dilation. This procedure involves the use of a flexible endoscope to view the esophagus, and a balloon with a diameter of less than 30 mm is used to dilate any strictures or narrowings in the esophagus. It is important to note that this code should not be reported in conjunction with other specific codes related to esophagoscopy and balloon dilation.

2. Official Description

The official description of CPT code 43220 is: ‘Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter).’ It is important to note the notes associated with this code, such as not reporting it with certain other esophagoscopy and balloon dilation codes, and the use of fluoroscopic guidance if performed.

3. Procedure

1. The procedure begins with the administration of anesthesia to the patient.
2. The physician inserts a flexible endoscope through the patient’s mouth, down the throat, and into the esophagus.
3. The provider inspects the esophagus and identifies any strictures or narrowings.
4. A balloon with a diameter of less than 30 mm is inserted through the scope and positioned across the stricture.
5. The balloon is then inflated, gradually increasing the diameter of the stricture and dilating the area.
6. Once the area of narrowing has been dilated to the desired size, the balloon dilator is removed.
7. Finally, the scope is carefully removed from the patient.

4. Qualifying circumstances

CPT 43220 is performed on patients who have strictures or narrowings in their esophagus that require dilation. It is important to note that this code should not be reported with other specific esophagoscopy and balloon dilation codes. Fluoroscopic guidance may be used during the procedure, in which case the appropriate code for fluoroscopic guidance should be reported separately.

5. When to use CPT code 43220

CPT code 43220 should be used when performing esophagoscopy with transendoscopic balloon dilation using a flexible endoscope and a balloon with a diameter of less than 30 mm. It is important to ensure that the procedure meets the specific criteria outlined in the code description and that it is not reported with other specific esophagoscopy and balloon dilation codes.

6. Documentation requirements

To support a claim for CPT code 43220, the following documentation should be included:

• Patient’s medical record with the diagnosis and indication for the procedure
• Description of the procedure performed, including the use of a flexible endoscope and a balloon with a diameter of less than 30 mm
• Date and duration of the procedure
• Details of any fluoroscopic guidance used, if applicable
• Any complications or adverse events that occurred during the procedure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT code 43220, it is important to ensure that the procedure meets the specific criteria outlined in the code description. This code should not be reported with other specific esophagoscopy and balloon dilation codes. If fluoroscopic guidance is performed during the procedure, the appropriate code for fluoroscopic guidance should be reported separately. It is important to follow the specific guidelines provided by the payer and to accurately document the procedure to support the billing claim.

8. Historical information

CPT code 43220 was added to the Current Procedural Terminology system on January 1, 1990. It underwent a code change on January 1, 2014, with the updated description reflecting the use of a flexible endoscope for the procedure.

9. Examples

1. A gastroenterologist performs an esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter) on a patient with esophageal strictures.
2. A patient with difficulty swallowing undergoes an esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter) to alleviate the narrowing in their esophagus.
3. A physician uses a flexible endoscope and a balloon with a diameter of less than 30 mm to dilate an esophageal stricture during an esophagoscopy procedure.
4. An individual with a history of esophageal strictures undergoes a routine esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter) to maintain the patency of their esophagus.
5. A patient with dysphagia undergoes an esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter) to improve their ability to swallow.
6. A gastroenterologist performs an esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter) on a patient with a history of gastroesophageal reflux disease (GERD) and esophageal strictures.
7. An individual with a narrowing in their esophagus undergoes an esophagoscopy with transendoscopic balloon dilation (less than 30 mm diameter) to alleviate their symptoms of dysphagia.
8. A physician uses a flexible endoscope and a balloon with a diameter of less than 30 mm to dilate an esophageal stricture during an esophagoscopy procedure.