2025 CPT code 43215
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagoscopy Procedures Surgery Feed
Flexible transoral esophagoscopy with foreign body removal.
Modifiers may be applicable depending on the circumstances of the procedure.Examples include modifier 22 (increased procedural services) if the removal was significantly more complex than usual, and modifier 51 (multiple procedures) if performed with other procedures.
Medical necessity for this procedure is established when a foreign body is present in the esophagus causing symptoms or posing a risk of complications such as perforation or obstruction. Documentation should clearly support the need for endoscopic removal.
The physician is responsible for performing the esophagoscopy, identifying the foreign body, and using appropriate instruments to safely remove it.Pre-operative preparation, anesthesia administration (if applicable), and post-operative care may be the responsibility of other healthcare professionals.
In simple words: The doctor uses a thin, flexible tube with a camera (endoscope) inserted through the mouth to examine the esophagus and remove any foreign objects that are stuck there.
This procedure involves the insertion of a flexible endoscope through the patient's mouth into the esophagus to visualize and remove a foreign body.The procedure includes examination from the cricopharyngeus muscle to the gastroesophageal junction, potentially extending to the proximal stomach via retroflexion. Removal of the foreign body is accomplished using instruments passed through the endoscope's working channel.Bleeding control during the same operative session is not separately reported.
Example 1: A 2-year-old child presents with a coin lodged in their esophagus.The physician performs a flexible esophagoscopy and successfully removes the coin under direct visualization., An adult patient presents after choking on a piece of meat. A flexible esophagoscopy is performed, revealing a partially obstructing piece of meat that is removed using grasping forceps., A patient swallows a small, irregularly shaped bone that becomes embedded in the esophageal mucosa.The physician performs a flexible esophagoscopy to remove the bone fragment.
* Pre-procedure assessment including patient history and physical examination.* Indication for the procedure (e.g., foreign body obstruction).* Detailed procedural report including description of the foreign body, location, and method of removal.* Images (if obtained) documenting the procedure and the removed foreign body.* Post-procedure assessment and plan of care.* Anesthesia documentation (if applicable).
** If the foreign body is removed using a rigid esophagoscope, CPT code 43194 is the appropriate code. This code should only be used if the foreign body is removed, even if other endoscopic procedures were also performed during the same session.Accurate documentation is critical for appropriate reimbursement.
- Revenue Code: P8B (Endoscopy - Upper Gastrointestinal)
- RVU: The relative value units (RVUs) for CPT code 43215 vary based on geographic location and payer. Consult the relevant Medicare Physician Fee Schedule (MPFS) or payer-specific fee schedule for the most current RVU values and reimbursement rates.
- Global Days : The global period for this procedure is not explicitly defined in the provided sources and requires further research based on the specific payer and geographical location.It is crucial to consult local payer guidelines.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code.
- Fee Schedule : Historical fee schedules for CPT code 43215 are not available in provided sources.Consult payer-specific fee schedules for historical data.
- Specialties:Gastroenterology, Otolaryngology
- Place of Service:Office, Ambulatory Surgery Center, Hospital (Inpatient or Outpatient)