2025 CPT code 43204
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices.
Modifiers may be applicable in certain situations, such as multiple procedures (modifier 51), reduced services (modifier 52), or when the procedure was discontinued (modifier 53). Consult the current CPT manual for specific modifier guidelines.
Injection sclerotherapy for esophageal varices is medically necessary to prevent or control bleeding in patients with portal hypertension or liver disease at high risk of hemorrhage.The procedure is often performed in patients who may not be candidates for banding or who require additional therapy to control bleeding in patients who have already had banding.
A gastroenterologist or other qualified physician performs this procedure. Responsibilities include pre-procedural patient evaluation, obtaining informed consent, performing the esophagoscopy and injection sclerotherapy, monitoring the patient's condition during and after the procedure, and providing post-procedural care and follow-up.This would involve preparing the patient, inserting the endoscope, identifying varices, injecting the sclerosing agent, and managing any complications.
In simple words: The doctor inserts a thin, flexible tube with a camera on the end through the mouth to look at the esophagus (the tube connecting the mouth to the stomach).If there are enlarged blood vessels (varices) that might bleed, the doctor injects a special solution into them to close them off and stop bleeding. This is done while the patient is asleep under anesthesia.
This procedure involves inserting a flexible endoscope transorally to examine the esophagus and inject a sclerosing agent into esophageal varices (enlarged blood vessels) to control bleeding.The procedure is performed under anesthesia. A sclerosant is injected into the submucosa of the varices, leading to thrombosis and adherence of the varix walls.This is a common treatment for esophageal varices that are at high risk of bleeding.
Example 1: A 55-year-old male with cirrhosis and large esophageal varices presents with hematemesis.The physician performs a flexible esophagoscopy and injects a sclerosing agent into the varices to control bleeding. , A 60-year-old female with a history of portal hypertension has recurrent episodes of minor bleeding from esophageal varices.The physician performs an esophagoscopy with injection sclerotherapy as a prophylactic measure., A 48-year-old patient with alcoholic cirrhosis develops massive upper gastrointestinal bleeding. During emergency endoscopy, a large bleeding esophageal varix is identified. Injection sclerotherapy is used in conjunction with other measures to control the bleeding immediately.
* Complete patient history and physical examination noting the presence of esophageal varices and bleeding symptoms.* Documentation justifying the medical necessity for the procedure.* Informed consent.* Anesthesia records, if anesthesia is administered.* Procedure notes accurately documenting the location, number, and size of varices treated.* Type and amount of sclerosing agent used.* Number of injection sites.* Post-procedure findings and the patient's response.* Post-procedure instructions.* Pathology report, if applicable.
** The procedure may be repeated as needed to achieve complete control of variceal bleeding.The success rate varies depending on factors such as the severity of the varices and the patient's overall health.Always use the most current and accurate coding guidelines from authoritative sources when submitting medical claims.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: This information requires access to specific payer fee schedules and may vary based on geographic location and other factors.RVUs are not provided in the source data.
- Global Days: The global period for this procedure would depend on the specific payer and may vary.Additional information is needed to determine the exact global days.
- Payment Status: Active
- Modifier TC rule: The application of TC (Technical Component) modifiers is dependent on the specific payer and their billing rules. There is no definitive statement on TC in the given data.
- Fee Schedule: Historical fee schedule data is not included in the provided information and will vary significantly based on location and payer.Use a reputable fee schedule database for accurate information.
- Specialties:Gastroenterology, Hepatology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center