How To Use CPT Code 43226

CPT 43226 describes the procedure of esophagoscopy, which involves the use of a flexible endoscope to view and treat abnormalities in the esophagus. 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 43226?

CPT 43226 is a code used to describe the procedure of esophagoscopy. This procedure involves the insertion of a flexible endoscope through the mouth to view and treat abnormalities in the esophagus. It is commonly used to widen a narrowed area of the esophagus by passing dilators over a guidewire.

2. Official Description

The official description of CPT code 43226 is: ‘Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire.’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. The provider inserts a flexible endoscope through the patient’s mouth, down the throat, and into the esophagus.
3. The provider inspects the esophagus for any abnormalities or narrowing.
4. A guidewire, such as a Savary-Gillard wire, is passed through the endoscope and into the esophagus.
5. The endoscope is then removed, leaving the guidewire in place.
6. The provider selects dilators of increasing sizes and passes them over the guidewire into the narrowed area of the esophagus.
7. The dilators are expanded to widen the esophagus and improve the patient’s condition.
8. Once the desired level of dilation is achieved, the guidewire is removed.

4. Qualifying circumstances

CPT 43226 is used for patients who require esophagoscopy to treat a narrowing of the esophagus. This procedure is typically performed by a healthcare provider who is experienced in using a flexible endoscope and performing dilations. It is important to note that CPT 43226 should not be reported in conjunction with other codes for the same lesion or with certain other esophagoscopy codes.

5. When to use CPT code 43226

CPT code 43226 should be used when a healthcare provider performs esophagoscopy with the insertion of a guide wire followed by the passage of dilators over the guide wire. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If fluoroscopic guidance is used during the procedure, a different code should be used.

6. Documentation requirements

To support a claim for CPT 43226, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for esophagoscopy
• Specific details of the procedure, including the use of a flexible endoscope, insertion of a guide wire, and passage of dilators
• Date and duration of the procedure
• Any complications or additional interventions performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43226, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The use of other codes for the same lesion or certain other esophagoscopy codes should be avoided. If fluoroscopic guidance is used during the procedure, a different code should be reported. It is important to follow the appropriate coding guidelines and modifiers when reporting CPT 43226.

8. Historical information

CPT 43226 was added to the Current Procedural Terminology system on January 1, 1990. There have been historical changes to the code, including a code change on January 1, 2014, which revised the description of the procedure.

9. Examples

1. A gastroenterologist performing esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire to treat a patient with esophageal stricture.
2. An otolaryngologist using a flexible endoscope to perform esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire for a patient with dysphagia.
3. A general surgeon performing esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire to treat a patient with a benign esophageal stricture.
4. An interventional radiologist assisting in esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire for a patient with esophageal stenosis.
5. A thoracic surgeon performing esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire to treat a patient with esophageal cancer.
6. A gastroenterologist using a flexible endoscope to perform esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire for a patient with eosinophilic esophagitis.
7. An otolaryngologist performing esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire to treat a patient with a foreign body in the esophagus.
8. A general surgeon using a flexible endoscope to perform esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire for a patient with a benign esophageal stricture.
9. An interventional radiologist assisting in esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire for a patient with esophageal stenosis.
10. A thoracic surgeon performing esophagoscopy with the insertion of a guide wire followed by dilation over the guide wire to treat a patient with esophageal cancer.