2025 CPT code 43200
(Active) Effective Date: N/A Revision Date: N/A Surgical Procedures on the Digestive System - Esophagoscopy Surgery Feed
Flexible transoral esophagoscopy for diagnostic purposes, including specimen collection (brushing or washing) if performed; reported as a separate procedure.
Modifier 59 (Distinct procedural service) may be appended if performed with an unrelated procedure during the same session.Other modifiers may be applicable based on specific circumstances (refer to CPT guidelines for modifier usage).
Medical necessity for 43200 is established when symptoms (e.g., dysphagia, odynophagia, gastroesophageal reflux disease (GERD) symptoms, unexplained weight loss) warrant an endoscopic evaluation of the esophagus.The procedure may be medically necessary to diagnose or monitor esophageal pathology, including but not limited to: inflammation, strictures, varices, tumors, or foreign body ingestion.Payer specific guidelines may further define criteria for medical necessity.
The physician's responsibilities include patient preparation, anesthesia (if applicable), insertion of the endoscope, visualization of the esophagus and submucosal area, specimen collection (if performed), and interpretation of findings. Post-procedure care and follow-up are also the physician's responsibility.
In simple words: The doctor uses a thin, flexible tube with a camera and light (endoscope) to look inside the esophagus through the mouth.They may also collect samples for testing during the exam. This is done to find out what is causing problems like trouble swallowing, pain, or heartburn.
This CPT code (43200) represents a flexible transoral esophagoscopy performed for diagnostic reasons.The procedure involves inserting a flexible endoscope through the patient's mouth to visualize the esophagus.Specimen collection via brushing or washing may be included, but is not mandatory for code reporting.This code is reported as a separate procedure and should not be bundled with other related procedures performed during the same session unless modifier 59 is appended to indicate distinct procedural service.The procedure includes examination from the cricopharyngeus muscle to the gastroesophageal junction, and may extend to the proximal stomach via retroflexion.
Example 1: A 55-year-old male patient presents with dysphagia (difficulty swallowing).A flexible transoral esophagoscopy (43200) is performed to visualize the esophagus and rule out any structural abnormalities. No specimens were collected., A 70-year-old female patient presents with persistent heartburn and upper GI discomfort.A flexible transoral esophagoscopy (43200) is performed to assess the esophageal lining. Brush biopsies are collected for histopathological examination., A 30-year-old male presents after a recent ingestion of a small foreign body. Flexible transoral esophagoscopy (43200) is performed. The foreign body is successfully located and removed.No biopsy was performed.
* Preoperative assessment and patient history.* Procedure report detailing the findings, including the type of endoscope used (flexible, transoral).* Description of any specimens collected (brushing or washing) and their location.* Pathology report if specimens were analyzed.* Postoperative care instructions and follow-up plans.* Indication for the procedure.
** The collection of specimens by brushing or washing is optional but included in the code when performed.This code is for diagnostic purposes only. Therapeutic interventions performed during the same session are reported separately.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: Information not available in provided data. Refer to CMS data for RVU and reimbursement details.
- Global Days: The global period for this procedure is not specified in the given data. Refer to local payer guidelines for details on the global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Information not available in provided data. Refer to historical fee schedules from CMS.
- Specialties:Gastroenterology, Otolaryngology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center