How To Use CPT Code 43233

CPT 43233 describes a specific procedure known as esophagogastroduodenoscopy with dilation of the esophagus using a balloon. This article will provide an overview of CPT 43233, 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 43233?

CPT 43233 is a code used to describe a medical procedure called esophagogastroduodenoscopy with dilation of the esophagus using a balloon. This procedure involves the insertion of a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum. The healthcare provider then uses a balloon inflated to 30 mm or larger in diameter to dilate or widen the esophagus. Fluoroscopic guidance may be used during the dilation process.

2. Official Description

The official description of CPT code 43233 is: ‘Esophagogastroduodenoscopy, 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 other specific codes listed in the notes section.

3. Procedure

1. To perform CPT 43233, the healthcare provider administers anesthesia to the patient.
2. Next, the provider inserts a flexible endoscope through the patient’s mouth and passes it down the esophagus, through the stomach, and into the duodenum.
3. The provider inspects the structures of the esophagus, stomach, and duodenum using the endoscope.
4. A balloon dilator is then inserted through the endoscope and positioned at the level of the esophageal stricture.
5. The balloon is inflated to a diameter of 30 mm or larger to widen the narrowed area of the esophagus.
6. After achieving the desired dilation, the balloon dilator is removed.
7. The provider reinspects the esophagus and removes the endoscope.

4. Qualifying circumstances

CPT 43233 is performed on patients with esophageal strictures or narrowings that require dilation. The procedure is typically performed by a healthcare provider who specializes in gastroenterology or a similar field. It is important to note that CPT 43233 should not be reported with certain other specific codes, as indicated in the notes section.

5. When to use CPT code 43233

CPT code 43233 should be used when a healthcare provider performs esophagogastroduodenoscopy with dilation of the esophagus using a balloon. This code is appropriate when the dilation is performed with a balloon of 30 mm or larger in diameter. It is important to review the notes section to ensure that CPT 43233 is not reported in conjunction with other specific codes.

6. Documentation requirements

To support a claim for CPT 43233, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the esophageal 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 times of the procedure
• Details of the dilation process and any complications encountered
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43233, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The use of a balloon dilator with a diameter of 30 mm or larger should be documented. Additionally, review the notes section to ensure that CPT 43233 is not reported in conjunction with other specific codes. It is also important to follow any additional guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 43233 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 gastroenterologist performing esophagogastroduodenoscopy with dilation of the esophagus using a balloon for a patient with an esophageal stricture.
2. A patient with difficulty swallowing undergoing esophagogastroduodenoscopy with balloon dilation to widen the narrowed area of the esophagus.
3. A healthcare provider using fluoroscopic guidance during esophagogastroduodenoscopy with balloon dilation for a patient with a history of esophageal strictures.
4. A gastroenterologist performing esophagogastroduodenoscopy with balloon dilation to treat a patient with dysphagia caused by an esophageal narrowing.
5. A patient with a history of esophageal strictures undergoing esophagogastroduodenoscopy with balloon dilation to improve swallowing function.
6. A healthcare provider performing esophagogastroduodenoscopy with balloon dilation to treat a patient with recurrent esophageal strictures.
7. A gastroenterologist using a balloon dilator with a diameter of 30 mm or larger during esophagogastroduodenoscopy to widen the narrowed area of the esophagus.
8. A patient with a history of esophageal strictures undergoing esophagogastroduodenoscopy with balloon dilation to alleviate swallowing difficulties.
9. A healthcare provider performing esophagogastroduodenoscopy with balloon dilation to treat a patient with an esophageal stricture caused by acid reflux.