2025 CPT code 43213
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed).
Modifiers applicable: 22 (Increased Procedural Services), 26 (Professional Component), 52 (Reduced Services), 53 (Discontinued Procedure), 59 (Distinct Procedural Service), 76 (Repeat Procedure by Same Physician), 77 (Repeat Procedure by Another Physician).Modifier 59 is used for each additional stricture dilated in the same session.
Medical necessity must be established by documenting the patient's symptoms, the clinical findings supporting the diagnosis of esophageal stricture (e.g., imaging studies, prior endoscopy), and the expected benefit of the dilation procedure.
In simple words: The doctor uses a thin, flexible tube with a camera to look at your esophagus (the tube that connects your mouth to your stomach) and widen any narrow areas using a small balloon or dilating tool.An x-ray video may be used during the procedure to help guide the tools.
This code describes a procedure where a flexible endoscope is inserted through the mouth to view the esophagus and dilate it using a balloon or dilator in a retrograde approach (against the usual flow). Fluoroscopic guidance is included if performed.
Example 1: A patient with a history of esophageal stricture due to acid reflux presents with dysphagia (difficulty swallowing). The physician performs an esophagoscopy with retrograde balloon dilation (43213) to widen the narrowed area and improve swallowing., A patient undergoing chemotherapy develops an esophageal stricture as a side effect.The physician performs 43213 to alleviate the stricture and ensure the patient can maintain adequate nutrition., A patient with eosinophilic esophagitis, a chronic inflammatory condition, has developed multiple esophageal strictures. The physician performs 43213 with modifier 59 for each additional stricture dilated beyond the first.
Documentation should include the following: indication for the procedure (e.g., dysphagia, stricture), location and size of the stricture(s), type of dilation performed (balloon or dilator), use of fluoroscopy (if applicable), and any complications encountered.Pre-and post-procedure findings should also be noted.
- Specialties:Gastroenterology, Thoracic Surgery
- Place of Service:Ambulatory Surgical Center, Hospital Outpatient, Office