How To Use CPT Code 43255

CPT 43255 describes the procedure of esophagogastroduodenoscopy (EGD) with control of bleeding, using any method. 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 43255?

CPT 43255 is used to describe the procedure of esophagogastroduodenoscopy (EGD) with control of bleeding, using any method. This code is used when a healthcare provider uses a flexible endoscope to view the esophagus, stomach, and duodenum through the mouth. During the procedure, the provider also performs a method to control bleeding, such as chemical, electrocautery, heat probe, laser, or Argon plasma coagulation (APC).

2. Official Description

The official description of CPT code 43255 is: ‘Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method.’

3. Procedure

1. The healthcare provider administers anesthesia to the patient.
2. The provider inserts a flexible endoscope through the patient’s mouth and attempts to pass it through the pylorus into the duodenum and/or jejunum.
3. During the procedure, the provider uses various methods to control bleeding, such as chemical, electrocautery, heat probe, laser, or Argon plasma coagulation (APC).
4. The provider may use Argon plasma coagulation (APC) to coagulate the blood in a specific area or tissue.

4. Qualifying circumstances

CPT 43255 is performed on patients who require an esophagogastroduodenoscopy (EGD) with control of bleeding. This procedure is used to view the esophagus, stomach, and duodenum through a flexible endoscope. The patient may have a lesion or condition that requires control of bleeding. The provider must use any method available, such as chemical, electrocautery, heat probe, laser, or Argon plasma coagulation (APC), to control the bleeding during the procedure.

5. When to use CPT code 43255

CPT code 43255 should be used when a healthcare provider performs an esophagogastroduodenoscopy (EGD) with control of bleeding, using any method. This code should not be reported in conjunction with other codes for the same lesion or condition.

6. Documentation requirements

To support a claim for CPT 43255, the healthcare provider must document the following information:

• Reason for performing the esophagogastroduodenoscopy (EGD) with control of bleeding
• Specific method used to control bleeding, such as chemical, electrocautery, heat probe, laser, or Argon plasma coagulation (APC)
• Date and time of the procedure
• Details of the procedure, including the areas of the esophagus, stomach, and duodenum examined
• Any complications or adverse events that occurred during the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43255, ensure that the procedure meets the criteria for esophagogastroduodenoscopy (EGD) with control of bleeding, using any method. Do not report CPT 43255 in conjunction with other codes for the same lesion or condition. Follow the specific guidelines provided by the payer for accurate billing and reimbursement.

8. Historical information

CPT 43255 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2014, when it was combined with other terms to describe the procedure more accurately.

9. Examples

1. A healthcare provider performs an esophagogastroduodenoscopy (EGD) with control of bleeding using a heat probe to coagulate blood in a patient with a bleeding gastric ulcer.
2. During an esophagogastroduodenoscopy (EGD), a provider uses Argon plasma coagulation (APC) to control bleeding in a patient with esophageal varices.
3. A healthcare provider performs an esophagogastroduodenoscopy (EGD) with control of bleeding using electrocautery to stop bleeding in a patient with a bleeding duodenal ulcer.
4. During an esophagogastroduodenoscopy (EGD), a provider uses a laser to control bleeding in a patient with a bleeding gastric tumor.
5. A healthcare provider performs an esophagogastroduodenoscopy (EGD) with control of bleeding using chemical methods to stop bleeding in a patient with a bleeding esophageal lesion.
6. During an esophagogastroduodenoscopy (EGD), a provider uses a heat probe to coagulate blood in a patient with a bleeding duodenal polyp.
7. A healthcare provider performs an esophagogastroduodenoscopy (EGD) with control of bleeding using electrocautery to stop bleeding in a patient with a bleeding gastric ulcer.