2025 CPT code 43254
(Active) Effective Date: N/A Revision Date: N/A Surgery - Endoscopic Procedures Surgery Feed
Esophagogastroduodenoscopy with endoscopic mucosal resection.
Modifiers may apply depending on the specific circumstances of the procedure (e.g., 51 for multiple procedures, 52 for reduced services, 53 for discontinued procedure, etc.).
Medical necessity for this procedure is established by the presence of a clinically significant lesion in the esophagus, stomach or duodenum which necessitates endoscopic resection for diagnosis and/or treatment.This could be based on symptoms, imaging studies, or other clinical findings.
The gastroenterologist or other qualified physician inserts the endoscope, examines the upper gastrointestinal tract, performs the EMR, and manages any post-procedure complications. Anesthesiologist may be involved for sedation.
In simple words: A doctor uses a thin, flexible tube with a camera on the end (endoscope) to look at your esophagus (the tube that connects your mouth to your stomach), stomach, and the first part of your small intestine (duodenum).If they find an abnormal area, they may remove it using special tools through the endoscope.
Esophagogastroduodenoscopy (EGD) is performed using a flexible endoscope inserted orally.The procedure involves examination of the esophagus, stomach, and duodenum.Endoscopic mucosal resection (EMR) is the excision of a mucosal lesion identified during the EGD. This may involve submucosal injection to elevate the lesion before resection. The procedure concludes with removal of the endoscope and any instruments used.
Example 1: A patient presents with a suspicious polyp in the stomach during an upper endoscopy. The physician performs EMR to remove the polyp for pathological examination., A patient experiences recurrent gastrointestinal bleeding. EGD reveals a bleeding lesion in the duodenum, successfully treated with EMR., A patient with Barrett's esophagus undergoes EGD. Multiple dysplastic lesions are identified in the esophagus and treated by EMR. Biopsies are obtained for further histological analysis.
* Pre-procedure patient history and physical exam.* Indication for the procedure (e.g., symptoms, prior imaging).* Detailed endoscopic findings (location, size, characteristics of lesion).* Description of the EMR technique.* Pathology report of the resected tissue.* Post-procedure care instructions.
** This code encompasses various EMR techniques (injection-assisted, cap-assisted, ligation-assisted).Accurate documentation of the technique used is crucial for proper coding.
- Revenue Code: P8B
- RVU: This information requires accessing a specific fee schedule which is not available in the provided context.RVUs vary by location, payer, and other factors.
- Global Days : The global period for this procedure will depend on the specific circumstances and may vary.Consult your payer's guidelines.
- Payment Status: Active
- Modifier TC rule: The technical component (TC) modifier may apply depending on the specific circumstances of the procedure and the payer's rules. This would usually be modifier -TC.
- Fee Schedule : Historical fee schedule data is not available in the provided information.Consult relevant fee schedules based on date of service and payer.
- Specialties:Gastroenterology
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient and Outpatient)