2025 CPT code 43233
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Esophagogastroduodenoscopy (EGD) with esophageal dilation using a balloon of 30 mm or larger diameter (fluoroscopic guidance included when used).
Modifiers may be applicable in certain circumstances. For instance, modifier 52 may be used if the procedure is reduced in services, and modifier 53 is used if the procedure is discontinued.
Medical necessity must be established for this procedure. The documentation should support the presence of a clinically significant esophageal stricture causing symptoms or impairing function that warrants intervention.The medical record should also reflect the expected improvement in the patient's condition as a result of the procedure.
The physician administers anesthesia, inserts the endoscope, examines the relevant structures, performs the balloon dilation, and removes the instruments. They are responsible for the entire procedure, including pre- and post-operative care.
In simple words: The doctor uses a thin, flexible tube with a camera and light to look inside your esophagus, stomach, and small intestine. They then use a small balloon to stretch a narrowed area in your esophagus. An X-ray video might be used to help guide the procedure.
This code describes a procedure where a flexible endoscope is inserted through the mouth to examine the esophagus, stomach, and duodenum. During the procedure, the esophagus is dilated using a balloon inflated to a diameter of 30 mm or larger. Fluoroscopic guidance may be used to assist with the dilation.
Example 1: A patient with a history of esophageal stricture due to acid reflux presents with dysphagia. EGD with balloon dilation (43233) is performed to widen the narrowed area and improve swallowing., A patient undergoing chemotherapy develops an esophageal stricture as a side effect. EGD with balloon dilation (43233) is performed to alleviate the dysphagia and allow for adequate nutritional intake., A patient with eosinophilic esophagitis experiences difficulty swallowing. EGD with balloon dilation (43233) is performed to dilate the narrowed esophageal segments caused by inflammation.
Documentation should include the following information: indication for the procedure (e.g. dysphagia, stricture), size of the balloon used, pre- and post-dilation findings, any complications encountered, and confirmation of the location of the dilation within the esophagus.
- Revenue Code: P8B
- Specialties:Gastroenterology, General Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient, Office