Anesthesia Coding Alert

Procedure purpose is key when choosing the correct anesthesia code.

Esophagoscopy cases are incredibly common, with roughly 10 million seen annually in the United States alone. A specific type of endoscope, the esophagoscope, is used to visualize a patient’s esophagus. These procedures are used to diagnose issues like acid reflux, hiatal hernias, Barrett’s esophagus, strictures, and to remove foreign bodies. When transnasal entry is used, biopsies may be taken in some instances as well. Many of these scenarios require the patient to be placed under general anesthesia during the process.

Read on to learn more about the different entry points of the esophagoscope and how to code procedures using anesthesia services on your claims.

Look to These Anesthesia Codes for Esophagoscopy Procedures

CPT^® distinguishes the anesthesia codes for procedures in the digestive tract based on anatomical location. When coding for esophagoscopy procedures, you will look to the following codes most often:

• 00170 (Anesthesia for intraoral procedures, including biopsy; not otherwise specified)
• 00320 (Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older)
• 00326 (Anesthesia for all procedures on the larynx and trachea in children younger than 1 year of age)
• 00500 (Anesthesia for all procedures on esophagus).

Esophagoscopy Procedures Explained

If foreign body removal (FBR) is required, your provider may perform an esophagoscopy. Using the esophagoscope gives the practitioner a way to visualize the esophagus and entry to the stomach to investigate any conditions that may be affecting them. During this visualization, the practitioner can remove any blockages or foreign bodies, take tissue samples for testing, and examine the lining.

There are two esophagoscopy entry point options: transoral, where the provider passes the esophagoscope through the patient’s mouth; and transnasal, where the provider passes the scope through the patient’s nose.

For many transnasal procedures, the patient will remain conscious, and a numbing solution may be used instead to keep them comfortable. The thin endoscope used during this method goes through the nose and down into the esophagus. This procedure is mainly used for diagnostics and sometimes for small biopsies.

Transoral procedures can be performed as a rigid esophagoscopy, which uses a narrow tube with lenses, light, and an eyepiece. The method can be used to perform minor surgical procedures, and anesthesia is required. This method is usually performed by otolaryngologists (ENTs) or head and neck surgeons. Flexible esophagoscopy is a method that uses thin fibers to illuminate a patient’s gut. The fibers are also connected to a screen so the practitioner can view everything in real time. The patient would be moderately or deeply sedated during this procedure.

Look for These Esophagoscopy Codes

Choose esophagoscopy codes from 43180-43233 to report an endoscopic examination of the esophagus (even if the ENT surgeon accidentally enters the stomach, as may happen during the examination). The codes most often used are:

• 43191 (Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen[s] by brushing or washing when performed [separate procedure])
• 43192 (…with directed submucosal injection(s), any substance)
• 43193 (…with biopsy, single or multiple)
• 43194 (…with removal of foreign body(s))
• 43197 (Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))
• 43200 (Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure))

Note: For diagnostic transnasal esophagoscopies, use 43197. If your provider also performs a biopsy, CPT^® takes you to 43198 (Esophagoscopy, flexible, transnasal; with biopsy, single or multiple).

When additional services are provided, such as dilation, you may choose a code such as:

• 43220 (Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)
• 43226 (Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire)
• 43214 (Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed))
• 43212 (Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed))

Code This Scenario

A new patient visits the ENT surgeon’s office describing a painful sensation when they swallow. They describe it as feeling something scratching the inside of their throat and say that coughing and over-the-counter pain medication has brought no relief. During a brief history and exam, the patient explains that the pain began after eating at a buffet, which included chicken and prime rib. Because this has been bothering them for several days, the surgeon decides to place the patient under general anesthesia to perform an upper gastrointestinal endoscopic exam using rigid esophagoscopy to see what is causing the patient’s pain. The surgeon visualizes the esophagus and removes a small piece of chicken bone easily. Total anesthesia time is 26 minutes.

For this scenario, the procedure coding on your claim should look like this:

• Evaluation and management (E/M) code 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.) is appropriate for the brief medical history and exam of the patient.
• Modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) should be added to the office visit to indicate the E/M and the surgery were significant, separately identifiable services.
• Include 00320 x 2 for the anesthesia time, as anesthesia time is coded in 15-minute increments and the total time was 26 minutes. (With more than 8 minutes of anesthesia being administered after the initial 15, you are allowed to code for the second increment of 15 minutes).
• Report 43194 for the rigid esophagoscopy with removal of the foreign body.

The ICD-10-CM codes you will need are as follows:

• T18.12A (Bones in esophagus initial encounter) to indicate the final diagnosis
• R09.A2 (Foreign body sensation, throat) based on the patient’s chief complaint.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC