2025 CPT code 43195
Effective Date: N/A Surgery > Surgical Procedures on the Digestive System Feed
Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)
Modifiers applicable: 22, 47, 51, 52, 53, 58, 59, 73, 74, 76, 77, 78, 79, 99, and others as per individual payer policy.
Medical necessity must be established for this procedure. The documentation should support the need for the dilation, such as the impact of the stricture on the patient's ability to swallow and maintain adequate nutrition.
In simple words: The doctor inserts a rigid viewing tube through your mouth and into your esophagus.A small balloon is then inserted through the tube and inflated to widen any narrowed areas.
This code describes a procedure where a rigid endoscope is inserted through the mouth into the esophagus. A balloon dilator, less than 30mm in diameter, is then used to widen a narrowed area (stricture) in the esophagus.
Example 1: A patient presents with difficulty swallowing due to a benign esophageal stricture. A rigid esophagoscopy with balloon dilation (less than 30 mm) is performed to alleviate the stricture., A patient with a history of caustic ingestion has developed a narrowed area in their esophagus. The physician performs a rigid esophagoscopy and dilates the stricture with a balloon smaller than 30 mm in diameter., A child experiences difficulty swallowing food and is diagnosed with an esophageal stricture. A rigid esophagoscopy with balloon dilation using a balloon less than 30mm is performed.
Documentation should include the reason for the procedure (e.g., dysphagia, stricture), the location and size of the stricture, the size of the balloon dilator used, and any complications encountered during the procedure. The operative report should detail the procedure, including pre and post-dilation findings.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Specialties:Gastroenterology, Thoracic Surgery
- Place of Service:Ambulatory Surgical Center, Inpatient Hospital, and others if clinically appropriate.