How To Use CPT Code 43450

CPT 43450 describes the dilation of the esophagus using an unguided sound or bougie. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43450?

CPT 43450 is used to describe the dilation of the esophagus by a healthcare provider using an unguided sound or bougie. This procedure involves the insertion of long, thin tubular devices of increasing diameter to widen a stricture in the patient’s esophagus, improving their ability to swallow.

2. Official Description

The official description of CPT code 43450 is: ‘Dilation of esophagus, by unguided sound or bougie, single or multiple passes.’

3. Procedure

1. The patient is positioned supine on the procedure table and prepared and anesthetized as necessary.
2. The healthcare provider inserts a bougie or sound into the esophagus.
3. The provider may repeat this process several times, gradually increasing the diameter of the instrument with each pass.
4. The goal is to achieve sufficient or maximum dilation of the esophagus.
5. An endoscope may be used before and after the dilations to examine the stricture and check for any potential injury, but the dilations themselves are performed without the aid of an endoscope.
6. At the end of the procedure, the provider removes all instruments.

4. Qualifying circumstances

CPT 43450 is performed on patients with esophageal strictures that require dilation. The procedure is typically done by a healthcare provider who is trained and qualified to perform esophageal dilations. The patient must be appropriately prepped and anesthetized before the procedure. The use of an unguided sound or bougie is a key qualifying circumstance for this code.

5. When to use CPT code 43450

CPT code 43450 should be used when a healthcare provider performs the dilation of the esophagus using an unguided sound or bougie. This code is appropriate for both single and multiple passes of the instrument. It is important to note that this code should not be reported if radiological supervision and interpretation are involved, in which case code 74360 should be used instead.

6. Documentation requirements

To support a claim for CPT 43450, the healthcare provider must document the following information:

• Patient’s diagnosis necessitating the esophageal dilation
• Details of the procedure, including the use of an unguided sound or bougie
• Date and duration of the procedure
• Any complications or adverse events encountered
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43450, ensure that the procedure is performed by a qualified healthcare provider using an unguided sound or bougie. It is important to follow the specific guidelines and requirements set by the payer to ensure accurate and appropriate reimbursement. Additionally, be aware of any bundling or unbundling issues with other codes and modifiers that may affect billing for this procedure.

8. Historical information

CPT 43450 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A gastroenterologist performs the dilation of an esophageal stricture using an unguided sound for a patient with dysphagia.
2. A surgeon dilates the esophagus of a patient with a benign esophageal stricture using an unguided bougie.
3. A gastroenterologist performs multiple passes of an unguided sound to dilate an esophageal stricture in a patient with eosinophilic esophagitis.
4. An otolaryngologist uses an unguided bougie to dilate the esophagus of a patient with a history of head and neck cancer and radiation therapy.
5. A gastroenterologist performs the dilation of an esophageal stricture using an unguided sound for a patient with gastroesophageal reflux disease (GERD).
6. A surgeon dilates the esophagus of a patient with a peptic stricture using an unguided bougie.
7. A gastroenterologist performs multiple passes of an unguided sound to dilate an esophageal stricture in a patient with Barrett’s esophagus.
8. An otolaryngologist uses an unguided bougie to dilate the esophagus of a patient with a history of corrosive ingestion.
9. A gastroenterologist performs the dilation of an esophageal stricture using an unguided sound for a patient with achalasia.
10. A surgeon dilates the esophagus of a patient with a Schatzki ring using an unguided bougie.