2025 CPT code 43196
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire.
Modifiers may be applicable. Refer to current CPT guidelines.
Medical necessity must be established by documenting the patient's symptoms, prior treatments, and the clinical rationale for performing the procedure.
The physician administers anesthesia, inserts the rigid scope, inspects the esophagus, inserts the guidewire, removes the scope, and then dilates the esophagus over the guidewire.
In simple words: A rigid scope is inserted through the mouth to examine the esophagus. A guidewire is then placed, followed by dilators to widen the esophagus.
This code describes a procedure where a rigid endoscope is inserted through the mouth to view the esophagus.A guidewire is then inserted, followed by dilation over the guidewire.This procedure is distinct from flexible transoral esophagoscopy (43226) and should not be reported with 43191, 43197, or 43198. If fluoroscopic guidance is used, report 74360.
Example 1: A patient presents with dysphagia due to an esophageal stricture. A rigid esophagoscopy is performed with guidewire insertion and dilation to relieve the stricture., Following caustic ingestion, a patient develops esophageal narrowing. A rigid esophagoscopy with guidewire placement and dilation is performed to restore esophageal patency., A patient with eosinophilic esophagitis has difficulty swallowing.A rigid esophagoscopy with guidewire insertion and dilation is performed to improve the esophageal lumen.
Documentation should include the reason for the procedure, the size and type of dilators used, any complications encountered, and the post-procedure outcome.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Specialties:Gastroenterology, Otolaryngology
- Place of Service:Ambulatory Surgical Center, Hospital-Outpatient, Office