2025 CPT code 43227
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophagoscopy Digestive System Feed
Esophagoscopy, flexible, transoral; with control of bleeding, any method.
Modifiers may be applicable depending on the circumstances.For example, modifier 22 (increased procedural services) might be used if the bleeding control proved unusually complex or extensive.Modifiers 51 (multiple procedures) or 59 (distinct procedural service) could also apply in certain situations.
Medical necessity for 43227 is established by the presence of active esophageal bleeding requiring endoscopic intervention to control hemorrhage and prevent further complications like anemia, hypovolemic shock, or death.Documentation should support the need for the procedure, including clinical symptoms, physical exam findings, and lab results indicating blood loss.
The physician is responsible for administering anesthesia (if necessary), inserting and manipulating the endoscope, visualizing the esophagus, identifying the bleeding source, and employing the appropriate technique to control the bleeding. This may involve various methods, including injection, cautery, laser, or other hemostatic techniques. Post-procedure monitoring and documentation are also part of the clinical responsibility.
In simple words: The doctor uses a thin, flexible tube with a camera on the end (endoscope) to look inside the esophagus (the food tube connecting the mouth and stomach).If there's any bleeding, the doctor will stop it using different methods like heat, special chemicals, or small tools.
This CPT code encompasses the performance of a flexible transoral esophagoscopy with the simultaneous control of any bleeding encountered during the procedure.The procedure involves inserting a flexible endoscope through the mouth to visualize the esophagus from the cricopharyngeus muscle to the gastroesophageal junction, potentially extending to the proximal stomach via retroflexion.Bleeding control methods may include injection therapy, bipolar or unipolar cautery, laser, heater probe, stapler, or plasma coagulation.Note that this code should not be reported with codes 43201, 43204, 43205, 43197, 43198, or 43200 for the same lesion during the same operative session.
Example 1: A patient presents with acute esophageal bleeding after a recent trauma.The physician performs an esophagoscopy to locate the bleeding site and uses electrocautery to achieve hemostasis., A patient with a known esophageal varix experiences a significant hemorrhage.Emergency esophagoscopy is performed, and bleeding is controlled using injection sclerotherapy., During a routine esophagoscopy for dysphagia, a small area of bleeding is noted.The physician uses a heater probe to cauterize the bleeding point and completes the esophagoscopic exam.
Detailed operative report specifying the type of endoscope used, the extent of the esophageal examination, location and nature of the bleeding, method of hemostasis, and any complications.Preoperative and postoperative diagnoses should be clearly documented.Relevant imaging studies and pathology reports should be included.
** The use of this code assumes that the bleeding control is an integral part of the esophagoscopy and not a separate, independent procedure.If bleeding control represents a significant portion of the procedure, careful documentation is essential to ensure proper coding and reimbursement.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier would not typically be used with this code as it represents the entire procedure of esophagoscopy with bleeding control.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center