How To Use CPT Code 43251

CPT 43251 describes the procedure of esophagogastroduodenoscopy (EGD) with the removal of tumor(s), polyp(s), or other lesion(s) using a snare technique. 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 43251?

CPT 43251 is used to describe the procedure of esophagogastroduodenoscopy (EGD) with the removal of tumor(s), polyp(s), or other lesion(s) using a snare technique. This code is specifically used when the physician performs the procedure through the mouth using a flexible endoscope to view the esophagus, stomach, and duodenum. During the procedure, the physician identifies and removes one or more lesions using a snare technique, which involves passing a wire loop over the marked polyp or lesion to cut the stalk and minimize bleeding.

2. Official Description

The official description of CPT code 43251 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique.’ It is important to note that this code should not be reported in conjunction with code 43254 for the same lesion, and it should not be reported with codes 43197, 43198, 43235, 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44376, 44377, 44378, or 44379.

3. Procedure

1. The physician administers anesthesia to the patient.
2. A flexible endoscope is inserted into the patient’s mouth and passed through the pylorus into the duodenum and/or jejunum.
3. The physician inspects the gastrointestinal (GI) tract to locate the lesion(s) that need to be removed.
4. A snare technique is used to remove the lesion(s). The physician passes a wire loop over the marked polyp or lesion and applies a low power current to cut the stalk and coagulate the blood vessels to minimize bleeding.
5. One or more lesions may be removed during the procedure.
6. Once the procedure is completed, the scope is removed from the patient’s mouth.

4. Qualifying circumstances

CPT 43251 is performed on patients who require the removal of tumor(s), polyp(s), or other lesion(s) using a snare technique. The procedure is typically performed by a physician using a flexible endoscope. The patient may have lesions in the esophagus, stomach, or duodenum that need to be removed for diagnostic or therapeutic purposes.

5. When to use CPT code 43251

CPT code 43251 should be used when a physician performs an esophagogastroduodenoscopy with the specific intention of removing tumor(s), polyp(s), or other lesion(s) using a snare technique. This code should not be used for endoscopic mucosal resection, which has its own specific code (43254).

6. Documentation requirements

To support a claim for CPT 43251, the physician must document the following information:

• Patient’s diagnosis and the need for the procedure
• Specific details of the procedure, including the use of a snare technique and the removal of tumor(s), polyp(s), or other lesion(s)
• Date and duration of the procedure
• Location of the lesion(s) and any additional findings
• Any complications or adverse events that occurred during the procedure
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43251, ensure that the procedure is performed by a physician using a flexible endoscope through the mouth. It is important to note that this code should not be reported with code 43254 for the same lesion, and it should not be reported with codes 43197, 43198, 43235, 44360, 44361, 44363, 44364, 44365, 44366, 44369, 44370, 44372, 44373, 44376, 44377, 44378, or 44379. It is recommended to review the specific documentation requirements and guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 43251 was added to the Current Procedural Terminology system on January 1, 1990. The code was later updated on January 1, 2014, with a revised description that included the term “transoral” to specify the procedure being performed through the mouth.

9. Examples

1. A physician performing an esophagogastroduodenoscopy with the removal of a polyp using a snare technique.
2. A gastroenterologist removing a tumor from the stomach during an esophagogastroduodenoscopy.
3. A surgeon performing an esophagogastroduodenoscopy with the removal of multiple lesions using a snare technique.
4. A physician removing a polyp from the duodenum during an esophagogastroduodenoscopy.
5. An endoscopist performing an esophagogastroduodenoscopy with the removal of a lesion using a snare technique.
6. A gastroenterologist removing a tumor from the esophagus during an esophagogastroduodenoscopy.
7. A surgeon performing an esophagogastroduodenoscopy with the removal of a polyp and a lesion using a snare technique.