2025 CPT code 43266
Effective Date: N/A Surgery - Esophagogastroduodenoscopy Procedures Feed
Esophagogastroduodenoscopy (EGD), flexible, transoral; with placement of an endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed).
Modifiers may be applicable in certain situations (e.g., 52 for reduced services, 53 for discontinued procedures, etc.).
Medical necessity is established by documenting the patient's symptoms (e.g., dysphagia, pain) related to the esophageal stricture, and the rationale for stent placement as a necessary intervention to alleviate these symptoms and improve the patient's condition.
The physician prepares the patient, administers anesthesia, inserts the endoscope, inspects the relevant areas, dilates as needed, places the stent, and removes the instruments.
In simple words: A thin, flexible tube with a camera is inserted through your mouth to examine your esophagus, stomach, and the beginning of your small intestine. A stent (a small tube) is then placed in a narrowed area of your esophagus to keep it open. The doctor may also widen the esophagus before and after placing the stent.
This code describes a procedure where a flexible endoscope is inserted through the mouth to examine the esophagus, stomach, and duodenum. During the procedure, an endoscopic stent is placed, often involving pre- and post-dilation using guide wires.
Example 1: A patient with esophageal cancer has a stricture that is causing difficulty swallowing. An EGD with stent placement is performed to alleviate the blockage and improve the patient's ability to eat., A patient with a benign esophageal stricture undergoes EGD with stent placement to widen the narrowed area and restore normal swallowing function., A patient who has undergone radiation therapy for esophageal cancer develops a stricture. An EGD with stent placement is performed to maintain the opening of the esophagus.
Documentation should include details of the EGD, the location and nature of the stricture, the type of stent placed, and any pre- or post-dilation performed. Medical necessity should be clearly documented, such as the symptoms related to the stricture and the rationale for stent placement.
** If fluoroscopic guidance is used, report code 74360 separately. Moderate (conscious) sedation should be billed separately using appropriate HCPCS codes, and it's crucial to consult payer policies for specific billing procedures.
- Specialties:Gastroenterology, General Surgery, Thoracic Surgery.
- Place of Service:Ambulatory Surgical Center, Hospital Inpatient, Hospital Outpatient