How To Use CPT Code 43236

CPT 43236 describes a specific procedure known as esophagogastroduodenoscopy (EGD) with directed submucosal injection(s) using a flexible endoscope. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43236?

CPT 43236 is a code used to describe the procedure of esophagogastroduodenoscopy (EGD) with directed submucosal injection(s) using a flexible endoscope. This procedure involves the insertion of a flexible endoscope through the mouth and down into the esophagus, stomach, and duodenum. During the procedure, the provider performs one or more injections into the submucosa, which is the tissue below the mucous membrane.

2. Official Description

The official description of CPT code 43236 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance.’

3. Procedure

1. The provider prepares the patient and administers anesthesia if necessary.
2. A flexible endoscope is inserted through the patient’s mouth and maneuvered through the esophagus, stomach, and duodenum.
3. The provider inspects the areas using the endoscope and performs one or more submucosal injections into the tissue below the mucous membrane.
4. The injections may involve various substances, such as botulinum toxin, steroids, India ink, or saline.
5. After the injections are completed, the provider removes all instruments.

4. Qualifying circumstances

CPT 43236 is used for patients who require an esophagogastroduodenoscopy with directed submucosal injection(s). This procedure may be performed for diagnostic or therapeutic purposes. It is important to note that CPT 43236 should not be reported in conjunction with certain other codes for the same lesion or condition.

5. When to use CPT code 43236

CPT code 43236 should be used when a provider performs an esophagogastroduodenoscopy with directed submucosal injection(s) using a flexible endoscope. This code is appropriate for both diagnostic and therapeutic procedures. However, it is important to review payer and coding guidelines to ensure accurate reporting.

6. Documentation requirements

To support a claim for CPT 43236, the provider must document the following information:

• Patient’s diagnosis or reason for the procedure
• Details of the procedure, including the use of a flexible endoscope and the specific areas inspected
• Description of the submucosal injections performed, including the substances used
• Any additional relevant information, such as complications or findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43236, ensure that the procedure meets the criteria outlined in the official description. It is important to review payer and coding guidelines to determine if any additional documentation or modifiers are required. Additionally, be aware of any codes that should not be reported in conjunction with CPT 43236 for the same lesion or condition.

8. Historical information

CPT 43236 was added to the Current Procedural Terminology system on January 1, 2003. There have been historical changes to the code, including a code change on January 1, 2014, which resulted in an updated description.

9. Examples

1. A gastroenterologist performing an esophagogastroduodenoscopy with directed submucosal injection of botulinum toxin to treat a patient with achalasia.
2. An otolaryngologist using a flexible endoscope to perform an esophagogastroduodenoscopy with directed submucosal injection of India ink to mark a lesion for surgical removal.
3. A surgeon performing an esophagogastroduodenoscopy with directed submucosal injection of steroids to treat a patient with esophageal strictures.
4. A gastroenterologist using a flexible endoscope to perform an esophagogastroduodenoscopy with directed submucosal injection of saline to lift a lesion for easier removal.
5. An interventional radiologist performing an esophagogastroduodenoscopy with directed submucosal injection of contrast dye to assist with imaging and diagnosis.