2025 CPT code 43211
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Esophagoscopy with endoscopic mucosal resection.
Modifiers may be necessary depending on the circumstances of the procedure. For example, modifier 51 may be used if multiple procedures are performed, and modifier 22 may be appropriate if the procedure is significantly more complex than typically involved.
Medical necessity for esophagoscopy with EMR is established based on clinical symptoms (e.g., dysphagia, bleeding), radiographic findings (e.g., suspicious lesion on endoscopy), or previous biopsy results (e.g., high-grade dysplasia in Barrett's esophagus).The need for resection depends on the presence of a lesion and the clinical concern for malignancy or complications.
The physician or qualified healthcare professional inserts and manipulates the endoscope, identifies and resects the esophageal lesion, and manages any complications that may arise during the procedure. Appropriate pre-operative and post-operative care is also the responsibility of the physician.
In simple words: The doctor inserts a thin, flexible tube with a camera and light into the patient's mouth to examine the esophagus. If a diseased area is found, the doctor removes it using a small instrument passed through the tube.
This procedure involves the insertion of a flexible endoscope through the patient's mouth into the esophagus.The provider visualizes the esophagus, identifies a lesion, injects a submucosal substance to elevate the lesion, and then resects (excises) the lesion from the esophageal mucosa.The scope is then removed.
Example 1: A patient presents with a suspected esophageal polyp.The physician performs an esophagoscopy and identifies a 1cm polyp.After submucosal injection, the polyp is resected using an EMR technique. Pathology is sent to confirm the diagnosis., A patient with a history of Barrett's esophagus undergoes surveillance esophagoscopy.A small area of dysplasia is identified and resected using EMR.The resected tissue is submitted for histopathological examination., A patient with dysphagia undergoes an esophagoscopy which reveals a superficial esophageal tumor.After submucosal injection, the physician performs an EMR resection to remove the lesion. Further treatment is planned based on pathology findings.
* Pre-procedure and post-procedure diagnoses.* Indication for the procedure (e.g., symptoms, imaging findings).* Detailed description of the procedure performed, including the location, size, and number of lesions resected.* Pathology report if applicable.* Any complications encountered during or after the procedure.* Appropriate anesthesia documentation.
** This code represents the removal of a mucosal lesion.If other procedures are done during the same session, those procedures should also be coded separately.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: Information not available in provided text.Refer to current CPT codebook or payer-specific guidelines for RVU values.
- Global Days: Information not available in provided text.Refer to current CPT codebook or payer-specific guidelines for global period information.
- Payment Status: Active
- Modifier TC rule: Information not available.Refer to current CPT codebook or payer-specific guidelines.
- Fee Schedule: Information not available in provided text.Refer to historical CPT fee schedules or payer-specific reimbursement data.
- Specialties:Gastroenterology, General Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)