How To Use CPT Code 43248

CPT 43248 describes a specific procedure used in esophagogastroduodenoscopy (EGD) to treat certain conditions. 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 43248?

CPT 43248 is a code used to describe a procedure performed during esophagogastroduodenoscopy (EGD). It involves the insertion of a guide wire followed by the passage of dilators through the esophagus over the guide wire. This procedure is typically done to widen the opening of a vessel, valve, or other structure in the upper gastrointestinal tract.

2. Official Description

The official description of CPT code 43248 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire.’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. A flexible endoscope is inserted through the patient’s mouth and down into the esophagus, stomach, and duodenum.
3. A guidewire is passed through the scope and into the desired location.
4. The scope is then removed, leaving the guidewire in place.
5. One or more dilators, such as the Savary-Gillard dilator, are inserted over the guidewire to widen the opening of the targeted structure.

4. Qualifying circumstances

CPT 43248 is typically performed for diagnostic or therapeutic purposes in patients with specific conditions affecting the upper gastrointestinal tract. It should not be reported in conjunction with certain other codes, such as 43197, 43198, 43235, and others. The procedure requires the use of a flexible endoscope, a guidewire, and dilators to widen the opening of the targeted structure.

5. When to use CPT code 43248

CPT code 43248 should be used when the healthcare provider performs the specific procedure of inserting a guide wire followed by the passage of dilators through the esophagus over the guide wire during an EGD. It is important to carefully review the documentation to ensure accurate code selection.

6. Documentation requirements

To support a claim for CPT 43248, the healthcare provider must document the following information:

• Reason for performing the procedure
• Details of the procedure, including the insertion of the guide wire and the passage of dilators
• Any complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43248, it is important to ensure that the procedure was performed as described in the official description. The code should not be reported with certain other codes, as mentioned earlier. It is also important to follow any specific guidelines provided by the payer regarding documentation and billing for this procedure.

8. Historical information

CPT 43248 was added to the Current Procedural Terminology system on January 1, 1994. There have been some historical changes to the code, including a code change on January 1, 2014, which resulted in the current description.

9. Examples

1. A healthcare provider performs an EGD on a patient and inserts a guide wire followed by the passage of dilators through the esophagus to widen a narrowed esophageal opening.
2. During an EGD, a healthcare provider inserts a guide wire and passes dilators through the esophagus to dilate a strictured area.
3. A patient undergoes an EGD, and the healthcare provider performs the procedure of inserting a guide wire followed by the passage of dilators through the esophagus to treat a benign esophageal stricture.
4. During an EGD, a healthcare provider inserts a guide wire and passes dilators through the esophagus to widen a narrowed esophageal opening caused by a tumor.
5. A healthcare provider performs an EGD on a patient and inserts a guide wire followed by the passage of dilators through the esophagus to treat a patient with difficulty swallowing due to a narrowed esophageal opening.
6. During an EGD, a healthcare provider inserts a guide wire and passes dilators through the esophagus to dilate a strictured area caused by gastroesophageal reflux disease (GERD).
7. A patient undergoes an EGD, and the healthcare provider performs the procedure of inserting a guide wire followed by the passage of dilators through the esophagus to treat a patient with a benign esophageal stricture caused by long-term acid reflux.
8. During an EGD, a healthcare provider inserts a guide wire and passes dilators through the esophagus to widen a narrowed esophageal opening caused by a tumor.
9. A healthcare provider performs an EGD on a patient and inserts a guide wire followed by the passage of dilators through the esophagus to treat a patient with difficulty swallowing due to a narrowed esophageal opening.
10. During an EGD, a healthcare provider inserts a guide wire and passes dilators through the esophagus to dilate a strictured area caused by gastroesophageal reflux disease (GERD).