2025 CPT code 43270
(Active) Effective Date: N/A Revision Date: N/A Surgery - Endoscopy Digestive System Feed
Esophagogastroduodenoscopy (EGD) with ablation of lesions (includes pre- and post-dilation and guidewire passage, if performed).
Modifiers such as 52 (reduced services), 53 (discontinued procedure), 76 (repeat procedure), and others, may be applicable depending on the circumstances of the procedure.Consult the most up-to-date CPT guidelines and payer-specific guidelines.
Medical necessity is established when EGD with ablation is deemed necessary to treat or manage a clinically significant lesion in the upper gastrointestinal tract.This may include precancerous lesions, polyps, tumors, or bleeding sources that are amenable to endoscopic ablation. Documentation must support the clinical indication for this procedure.
A gastroenterologist or other qualified physician performs the procedure, inserting the endoscope, visualizing the structures, and performing the ablation. Pre- and post-procedure care are also provided.Anesthesiologist may be involved if sedation is administered.
In simple words: This procedure uses a thin, flexible tube with a camera and light on the end to examine your esophagus, stomach, and the beginning of your small intestine.If any abnormal areas are found, the doctor can use the tube to destroy them using heat or other methods.This is done to remove diseased tissue without the need for major surgery.
This CPT code encompasses esophagogastroduodenoscopy (EGD), a procedure involving the insertion of a flexible endoscope through the mouth to visualize the esophagus, stomach, and duodenum.The procedure includes the ablation (destruction) of one or more lesions, polyps, or tumors.Pre- and post-dilation, as well as guidewire passage, are included if performed during the same session.Ablation methods may include radiofrequency ablation, cryotherapy, or other suitable techniques.The procedure is typically performed under conscious sedation.
Example 1: A patient with Barrett's esophagus undergoes EGD with radiofrequency ablation to destroy precancerous tissue., A patient presents with a suspicious polyp in the stomach during an EGD, which is then ablated via the endoscope., A patient with a bleeding ulcer undergoes EGD and the bleeding is controlled with ablation of the source of bleeding.
* Detailed history and physical exam* Indication for the procedure (e.g., abnormal endoscopic findings, bleeding)* Preoperative and post-operative assessment* Description of the endoscopic findings* Type of ablation performed* Number and location of lesions treated* Pathology report (if biopsy performed)* Any complications encountered
** This code includes pre- and post-dilation and guidewire placement if performed as part of the ablation procedure.Specific ablation techniques are not separately coded.
- Revenue Code: P8B (ENDOSCOPY - UPPER GASTROINTESTINAL)
- RVU: This information varies based on geographic location, payer, and facility type.Consult the appropriate fee schedule.
- Global Days: Not applicable. This is not a surgical procedure with a defined global period.
- Payment Status: Active
- Modifier TC rule: Not applicable, as this is not a procedure with a technical component.
- Fee Schedule: Fee schedules vary by payer, geographic location, and facility type.Consult the appropriate fee schedule for historical data.
- Specialties:Gastroenterology, Surgery
- Place of Service:Office, Ambulatory Surgical Center, Hospital (Inpatient or Outpatient)