2025 CPT code 43210
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagogastroduodenoscopy (EGD) with partial or complete esophagogastric fundoplasty, including duodenoscopy when performed.
Modifiers may be applicable based on circumstances such as reduced services (52), discontinued procedure (53), or multiple procedures (51).Consult the CPT manual for detailed guidance on modifier use.
Medical necessity is determined based on the patient's symptoms, clinical findings, and the failure of conservative management of GERD.Documentation must support the need for surgical intervention to improve esophageal function and alleviate symptoms.
The physician performs the EGD, assesses the esophageal and gastric anatomy, and performs the fundoplasty using an endoscopic approach. This includes inserting and manipulating the endoscope, placing sutures, and ensuring adequate hemostasis.Post-procedural care and follow-up are also the responsibility of the physician.
In simple words: The doctor uses a thin, flexible tube with a camera and light (endoscope) to examine the esophagus, stomach, and part of the small intestine.They also perform a procedure to strengthen the valve between the stomach and esophagus to help prevent acid reflux.
This CPT code encompasses a flexible, transoral esophagogastroduodenoscopy (EGD) procedure incorporating a partial or complete esophagogastric fundoplasty.The procedure involves the endoscopic examination of the esophagus, stomach, and duodenum (when clinically indicated).Fundoplasty, a surgical technique, is performed to reinforce the lower esophageal sphincter, thereby mitigating gastroesophageal reflux disease (GERD).Duodenoscopy is included in the coding when performed as part of the procedure.
Example 1: A 55-year-old patient presents with persistent heartburn and GERD symptoms despite medication.An EGD with fundoplasty is performed to address the reflux., A 40-year-old patient with a history of hiatal hernia undergoes an EGD to assess the extent of the hernia and receive a partial fundoplasty to improve esophageal function., A 60-year-old patient with a prior failed anti-reflux surgery undergoes an EGD with a complete fundoplasty to correct persistent GERD.
* Pre-operative assessment including patient history, physical examination, and relevant diagnostic testing (e.g., upper endoscopy report, pH studies).* Intraoperative findings, including images and descriptions of the procedure, type and extent of fundoplasty performed.* Post-operative care plan, including follow-up instructions and any complications.* Documentation of medical necessity.
** This code is specifically for the transoral endoscopic fundoplasty.Different codes apply to open surgical approaches.
- Revenue Code: 278 (Other Implants)
- RVU: This information varies by location and payer. Consult the Medicare Physician Fee Schedule (MPFS) or other payer's fee schedule for specific RVU values and reimbursement rates.
- Global Days : 0-day global period; post-operative visits are billed separately.
- Payment Status: Active
- Modifier TC rule: The TC modifier is not applicable to this code as it is a comprehensive procedure.
- Fee Schedule : Fee schedules vary by payer and location.Historically, reimbursement for this code has been influenced by changes in the MPFS and other payer policies.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)