How To Use CPT Code 43250

CPT 43250 describes the procedure of esophagogastroduodenoscopy (EGD) with the removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps. 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 43250?

CPT 43250 is used to describe a specific procedure called esophagogastroduodenoscopy (EGD) with the removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps. This code is used when a healthcare provider inserts a flexible esophagogastroduodenoscope through the mouth and examines the esophagus, stomach, and first portion of the small intestine. During the procedure, the provider identifies and removes abnormal masses or growths using hot biopsy forceps. The removed specimens are then sent to a laboratory for analysis.

2. Official Description

The official description of CPT code 43250 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure, ensuring appropriate prepping and anesthesia.
2. The provider inserts a flexible esophagogastroduodenoscope through the patient’s mouth and navigates it through the upper gastrointestinal (GI) tract.
3. Using the scope, the provider examines the esophagus, stomach, and first portion of the small intestine for any abnormal masses or growths.
4. If any tumor(s), polyp(s), or other lesion(s) are identified, the provider uses hot biopsy forceps to grasp and excise them.
5. During the excision, the hot biopsy forceps administer electrical current to cauterize the tissues and prevent bleeding.
6. The provider collects the excised specimens and sends them to a laboratory for further analysis.
7. Once the procedure is complete, the provider removes all instruments and withdraws the esophagogastroduodenoscope.

4. Qualifying circumstances

CPT 43250 is performed when a patient requires the removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps during an esophagogastroduodenoscopy. The procedure is typically indicated for patients with abnormal masses or growths in the esophagus, stomach, or first portion of the small intestine. It is important to note that CPT 43250 should not be reported in conjunction with certain other codes, as specified in the notes.

5. When to use CPT code 43250

CPT code 43250 should be used when a healthcare provider performs an esophagogastroduodenoscopy and removes tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps. This code is appropriate when the procedure involves the removal of abnormal masses or growths in the upper GI tract. It should not be used in conjunction with specific other codes, as mentioned in the notes.

6. Documentation requirements

To support a claim for CPT 43250, the healthcare provider must document the following information:

• Patient’s diagnosis and indication for the procedure
• Details of the procedure, including the use of hot biopsy forceps and the removal of tumor(s), polyp(s), or other lesion(s)
• Date and duration of the procedure
• Specific locations within the upper GI tract where abnormal masses or growths were identified and removed
• Details of the excised specimens and their submission to a laboratory for analysis
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43250, ensure that the procedure involves the removal of tumor(s), polyp(s), or other lesion(s) using hot biopsy forceps. It is important to follow the guidelines and not report CPT 43250 in conjunction with specific other codes, as mentioned in the notes. Additionally, consider any additional tips provided by coding experts to accurately report and maximize reimbursement for this procedure.

8. Historical information

CPT 43250 was added to the Current Procedural Terminology system on January 1, 1994. Since its addition, there have been historical changes and updates to the code, including modifications to the official description. It is important to stay updated with any revisions or additions to ensure accurate coding and billing.

9. Examples

1. A gastroenterologist performing an esophagogastroduodenoscopy and removing a polyp using hot biopsy forceps.
2. A surgeon conducting an esophagogastroduodenoscopy and excising a tumor from the stomach using hot biopsy forceps.
3. An oncologist performing an esophagogastroduodenoscopy and removing multiple lesions from the esophagus using hot biopsy forceps.
4. A gastroenterologist conducting an esophagogastroduodenoscopy and excising a polyp from the duodenum using hot biopsy forceps.
5. A physician performing an esophagogastroduodenoscopy and removing a lesion from the esophagus using hot biopsy forceps.
6. A surgeon conducting an esophagogastroduodenoscopy and excising a tumor from the first portion of the small intestine using hot biopsy forceps.
7. An oncologist performing an esophagogastroduodenoscopy and removing multiple polyps from the stomach using hot biopsy forceps.
8. A gastroenterologist conducting an esophagogastroduodenoscopy and excising a lesion from the esophagus using hot biopsy forceps.
9. A physician performing an esophagogastroduodenoscopy and removing a tumor from the duodenum using hot biopsy forceps.