2025 CPT code 43205
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagoscopy, flexible, transoral; with band ligation of esophageal varices.
Modifiers may be applicable based on the circumstances of the procedure (e.g., 51 for multiple procedures, 59 for distinct procedural service, 78 for unplanned return to the operating room).
Medical necessity for 43205 is established by the presence of esophageal varices, whether actively bleeding or at high risk of bleeding, and the need to prevent or control bleeding.
The physician is responsible for the proper preparation of the patient, insertion of the endoscope, identification and ligation of esophageal varices, and post-procedure monitoring.Anesthesia may be provided by the surgeon or anesthesiologist.
In simple words: A doctor uses a thin, flexible tube with a camera on the end to look inside the esophagus (the food pipe). If there are swollen blood vessels (varices) that could bleed, the doctor uses the tube to place small rubber bands around them to stop the bleeding.
This procedure involves the insertion of a flexible endoscope through the mouth into the esophagus to examine and treat esophageal varices (dilated blood vessels in the lower esophagus).Small elastic bands are placed around the base of the varices to cause thrombosis and prevent bleeding.The procedure may also include examination of the proximal stomach via retroflexion.Control of bleeding during the same operative session is not separately reported.
Example 1: A 55-year-old male with a history of cirrhosis presents with hematemesis. Endoscopy reveals large esophageal varices.43205 is used to ligate the varices., A 60-year-old female with portal hypertension undergoes esophagoscopy which reveals multiple small esophageal varices.43205 is performed to prevent future bleeding., A 48-year-old male with a history of alcohol abuse and liver disease is found to have actively bleeding esophageal varices during an upper endoscopy.43205 is performed to control the bleeding.
* Pre-procedure history and physical examination.* Indication for the procedure (e.g., bleeding varices, prevention of bleeding).* Detailed endoscopic findings, including location, size, and number of varices ligated.* Number of bands used.* Any complications encountered.* Post-procedure vital signs and assessment.
** This code is used for band ligation of esophageal varices.If sclerotherapy is performed, use code 43204.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier may be applicable depending on whether the procedure is performed by the surgeon or another qualified healthcare professional.
- Specialties:Gastroenterology, Hepatology, Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)