How To Use CPT Code 43231

CPT 43231 describes a specific procedure involving esophagoscopy and endoscopic ultrasound examination. This article will provide an overview of CPT code 43231, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43231?

CPT 43231 is a code used to describe a procedure that involves the insertion of a flexible endoscope through the mouth and down into the esophagus, along with the insertion of an ultrasound transducer through the endoscope to perform an endoscopic ultrasound (EUS) examination. This procedure allows the healthcare provider to evaluate and assess abnormalities of the esophageal wall or perform staging of an esophageal tumor.

2. Official Description

The official description of CPT code 43231 is: ‘Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination.’ It is important to note that this code should not be reported in conjunction with codes 43197, 43198, 43200, 43232, or 76975. Additionally, CPT 43231 should not be reported more than once per session.

3. Procedure

1. After the administration of anesthesia, the healthcare provider inserts a flexible endoscope through the patient’s mouth and down the throat, into the esophagus.
2. The provider then inspects the esophagus and inserts an ultrasound device to view the esophageal wall and nearby tissues.
3. During the procedure, the healthcare provider evaluates and assesses any abnormalities of the esophageal wall or performs staging of an esophageal tumor.
4. Once the examination is complete, the endoscope and ultrasound device are removed.

4. Qualifying circumstances

CPT 43231 is typically performed on patients who require an evaluation of the esophageal wall or staging of an esophageal tumor. It is important to note that this procedure should not be reported with certain other codes, such as 43197, 43198, 43200, 43232, or 76975. The healthcare provider must ensure that the patient meets the necessary criteria for this specific procedure.

5. When to use CPT code 43231

CPT code 43231 should be used when a healthcare provider performs a flexible esophagoscopy with an endoscopic ultrasound examination. This code is appropriate for reporting this specific procedure and should not be used for other similar procedures or examinations.

6. Documentation requirements

To support a claim for CPT code 43231, the healthcare provider must document the following information:

• Patient’s medical history and reason for the procedure
• Date and time of the procedure
• Details of the procedure, including the use of a flexible endoscope and ultrasound device
• Findings from the examination, including any abnormalities or staging information
• Any additional relevant information or notes from the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 43231, it is important to ensure that the procedure meets the specific criteria outlined in the code description. This includes the use of a flexible endoscope and an endoscopic ultrasound examination. Additionally, it should not be reported with certain other codes, such as 43197, 43198, 43200, 43232, or 76975. It is crucial to review the billing guidelines and requirements set forth by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT code 43231 was added to the Current Procedural Terminology system on January 1, 2001. It underwent a code change on January 1, 2014, when the description was updated to specify that the procedure involves flexible esophagoscopy. There have been no further updates or changes to the code since then.

9. Examples

1. A gastroenterologist performing a flexible esophagoscopy with endoscopic ultrasound examination to evaluate a patient with suspected esophageal cancer.
2. An oncologist staging an esophageal tumor using a flexible endoscope and ultrasound device during a procedure.
3. A surgeon performing a flexible esophagoscopy with endoscopic ultrasound examination to assess the extent of an esophageal wall abnormality.
4. A gastroenterologist using a flexible endoscope and ultrasound device to guide a fine needle aspiration biopsy of an esophageal lesion.
5. An interventional radiologist performing a flexible esophagoscopy with endoscopic ultrasound examination to assist in the placement of a localization device for future surgical intervention.
6. A healthcare provider using a flexible endoscope and ultrasound device to evaluate and assess the esophageal wall in a patient with chronic gastroesophageal reflux disease.
7. A thoracic surgeon performing a flexible esophagoscopy with endoscopic ultrasound examination to determine the stage of an esophageal tumor prior to surgical intervention.
8. An oncology nurse assisting a healthcare provider during a flexible esophagoscopy with endoscopic ultrasound examination to ensure patient comfort and safety.
9. A gastroenterologist using a flexible endoscope and ultrasound device to evaluate and assess the esophageal wall in a patient with Barrett’s esophagus.
10. A radiologist performing a flexible esophagoscopy with endoscopic ultrasound examination to guide the placement of a percutaneous gastrostomy tube in a patient with dysphagia.