2025 CPT code 43226
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire.
Modifiers may be applicable depending on the circumstances of the procedure.Consult the AMA CPT® codebook for appropriate modifier usage.
Medical necessity for this procedure is established based on clinical findings such as dysphagia, odynophagia (painful swallowing), weight loss, and radiographic evidence of esophageal stricture.The procedure is performed to improve swallowing function, prevent aspiration pneumonia, and enhance nutritional intake.
After administering anesthesia, the physician inserts a scope into the patient's mouth, guiding it down the throat into the esophagus for inspection.A guidewire is then passed, the scope removed, and dilators of increasing sizes are passed over the guidewire to expand the narrowed area.Once sufficient dilation is achieved, the guidewire is removed.
In simple words: This procedure uses a thin, flexible tube with a camera (endoscope) to look inside your esophagus (the tube connecting your mouth and stomach).If there's a narrowing, the doctor will use small instruments to gently stretch it open.
This CPT code encompasses a flexible, transoral esophagoscopy procedure.A guide wire is inserted, followed by the passage of one or more dilators over the guide wire to dilate a narrowed area of the esophagus (stricture).The procedure involves the visualization of the esophagus using a flexible endoscope inserted through the mouth, followed by the use of dilators to widen the esophageal lumen.This is typically performed to address esophageal strictures or obstructions.Bleeding control during the same operative session is not separately reported.
Example 1: A patient presents with dysphagia (difficulty swallowing) due to a benign esophageal stricture.A flexible esophagoscopy with dilation is performed to alleviate the swallowing difficulty., A patient with a history of caustic ingestion develops an esophageal stricture.A flexible esophagoscopy with dilation is performed to improve esophageal patency., A patient with eosinophilic esophagitis (EoE) experiences dysphagia.A flexible esophagoscopy is performed for evaluation, and dilation is performed if significant strictures are found.
* Pre-procedure assessment including patient history, physical examination, and relevant investigations (e.g., barium swallow, endoscopy reports).* Detailed procedural notes including the type of endoscope used, the location and characteristics of the stricture, the number and size of dilators used, and any complications encountered.* Post-procedure assessment and instructions to the patient, including dietary modifications and follow-up.* Images or videos of the procedure.
** This code should only be used when a guidewire is inserted and dilators are passed over the guidewire.If bleeding occurs during the procedure, it is not separately reported.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Office, Outpatient Hospital, Ambulatory Surgical Center