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The procedure described by CPT® Code 0654T refers to a flexible transnasal esophagogastroduodenoscopy (EGD) that includes the insertion of an intraluminal tube or catheter. This diagnostic procedure utilizes a flexible endoscope, which is a thin, tube-like instrument equipped with a light and camera, allowing for visualization of the upper gastrointestinal tract. The procedure begins with the introduction of the endoscope through the patient's nose, which is a less invasive approach compared to traditional oral insertion. This method facilitates examination of the velopharyngeal closure, base of the tongue, and hypopharynx, while also allowing for the assessment of vocal cord motion and pharyngeal musculature. As the endoscope is advanced, it reaches the esophagus, where the gastroesophageal junction is inspected for any abnormalities. The procedure continues as the endoscope is passed into the stomach, which is inflated with air to enhance visibility. Key areas of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, are thoroughly examined. Following this, the endoscope is further advanced into the duodenum and/or jejunum, where the mucosal surfaces are inspected for any signs of abnormalities. In conjunction with the visual examination, the procedure may involve the collection of tissue samples through brushing or washing techniques, as indicated by related codes 0652T and 0653T. Specifically, in the context of CPT® Code 0654T, the insertion of a transendoscopic tube or catheter is performed to facilitate nutritional delivery in patients experiencing swallowing difficulties, such as those with esophageal dysmotility. The endoscope is then withdrawn, and a nasoenteric tube is placed into the stomach, allowing for further advancement into the duodenum. This comprehensive approach ensures that any potential issues, such as ulcerations, varices, bleeding sites, lesions, or strictures, are identified and addressed during the procedure.
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The procedure described by CPT® Code 0654T is indicated for patients who require a detailed examination of the upper gastrointestinal tract, particularly when there are concerns regarding swallowing difficulties or other esophageal conditions. The following conditions may warrant the performance of this procedure:
The procedure involves several key steps that ensure a thorough examination and intervention as needed. Each step is critical for achieving the desired outcomes:
After the completion of the procedure, patients may require monitoring for any immediate complications, such as bleeding or perforation. It is essential to assess the patient's tolerance to the procedure and ensure that they are stable before discharge. Instructions regarding dietary modifications, especially if a nasoenteric tube has been placed, should be provided. Follow-up appointments may be necessary to review biopsy results or to assess the effectiveness of the nutritional support provided through the tube. Additionally, patients should be advised to report any unusual symptoms, such as persistent pain, fever, or difficulty swallowing, following the procedure.
| Short Descr | EGD FLX TRANSNASAL TUBE/CATH | Medium Descr | EGD FLEXIBLE TRANSNASAL W/INSJ INTRAL TUBE/CATH | Long Descr | Esophagogastroduodenoscopy, flexible, transnasal; with insertion of intraluminal tube or catheter | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 3 - Special payment adjustment rules for multiple endoscopic procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 1 - Statutory payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Endoscopic Base Code | 0652T Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | ASC Payment Indicator | Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight. | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2022-01-01 | Added | First appearance in codebook. |
| 2021-07-01 | Added | Code added. |
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