How To Use CPT Code 43253

CPT 43253 describes a specific procedure that involves the use of esophagogastroduodenoscopy (EGD) to view the esophagus, stomach, and duodenum. 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 43253?

CPT 43253 is a code used to describe a procedure called esophagogastroduodenoscopy (EGD) with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substances or fiducial markers. This procedure involves the use of a flexible endoscope inserted through the mouth to view the esophagus, stomach, and duodenum. During the procedure, the provider uses ultrasound guidance to inject substances or place fiducial markers. It is important to note that CPT 43253 should not be reported in conjunction with CPT 43240 for the same lesion, and there are other codes that should not be reported together with CPT 43253.

2. Official Description

The official description of CPT code 43253 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis).’ It is important to note the notes provided for this code, such as not reporting it with certain other codes and not reporting it more than once per session.

3. Procedure

1. The procedure begins with the administration of anesthesia to the patient.
2. The physician inserts a flexible endoscope through the patient’s mouth and attempts to pass it through the pylorus into the duodenum and/or jejunum.
3. Using ultrasound guidance, the physician inspects the gastrointestinal (GI) tract and performs an endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis.
4. During the procedure, the physician may inject one or more diagnostic or therapeutic substances, such as an anesthetic or neurolytic agent, or place fiducial markers.
5. Once the procedure is completed, the flexible endoscope is removed.

4. Qualifying circumstances

CPT 43253 is used for patients who require an esophagogastroduodenoscopy with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substances or fiducial markers. This procedure is typically performed for diagnostic or therapeutic purposes, such as injecting an anesthetic or neurolytic agent or placing fiducial markers. It is important to note that there are certain codes that should not be reported together with CPT 43253.

5. When to use CPT code 43253

CPT code 43253 should be used when performing an esophagogastroduodenoscopy with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substances or fiducial markers. It is important to follow the guidelines and notes provided for this code to ensure accurate reporting.

6. Documentation requirements

To support a claim for CPT 43253, the following documentation is required:

• Patient’s diagnosis and the need for the procedure
• Specific substances injected or fiducial markers placed
• Date and details of the procedure, including start and end times
• Ultrasound examination findings
• Any additional relevant information or findings
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43253, it is important to ensure that the procedure meets the criteria outlined in the official description. Additionally, be aware of the notes provided for this code, such as not reporting it with certain other codes and not reporting it more than once per session. It is important to follow the appropriate guidelines and modifiers when reporting this code.

8. Historical information

CPT 43253 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 physician performing an esophagogastroduodenoscopy with transendoscopic ultrasound-guided transmural injection of an anesthetic substance for a patient with esophageal cancer.
2. A gastroenterologist using ultrasound guidance to place fiducial markers during an esophagogastroduodenoscopy for a patient undergoing radiation therapy for pancreatic cancer.
3. A surgeon performing an esophagogastroduodenoscopy with transendoscopic ultrasound-guided transmural injection of a neurolytic agent for a patient with chronic pain in the upper GI tract.
4. An interventional radiologist using ultrasound guidance to inject a therapeutic substance during an esophagogastroduodenoscopy for a patient with a bleeding gastric ulcer.
5. A gastroenterologist performing an esophagogastroduodenoscopy with transendoscopic ultrasound-guided transmural injection of a diagnostic substance for a patient with suspected GI tract abnormalities.
6. A physician using ultrasound guidance to place fiducial markers during an esophagogastroduodenoscopy for a patient with esophageal varices.
7. A surgeon performing an esophagogastroduodenoscopy with transendoscopic ultrasound-guided transmural injection of a therapeutic substance for a patient with achalasia.