Otolaryngology Coding Alert

Question: How should I code a transnasal esophagoscopy (TNE)?

Louisiana Subscriber

Answer: Choose one of two CPT codes, depending on whether the TNE involved a biopsy. For a TNE in which the otolaryngologist does not perform a biopsy, report 43200 (Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). When the TNE involves a biopsy, use 43202 (... with biopsy, single or multiple).

Expect more payment for 43200 or 43202 when the otolaryngologist performs the TNE in the office instead of in a facility. The National Physician Fee Schedule assigns 5.59 transitional nonfacility total relative value units to 43200 as compared to 2.76 transitional facility total RVUs. Code 43202 contains 4.32 more transitional total RVUs in the office than in the facility--7.31 NF RVUs versus 2.99 RVUs.

Possible ICD-9 codes you can use with a TNE include:

• dysphagia, 787.2
• reflux esophagitis, 530.11
• hiatal hernia, 553.3
• aspiration, 933.1
• Barrett's esophagitis, 530.2x
• esophageal stricture, 530.3
• Zenker's diverticulum, 530.6.

Encourage your otolaryngologist to document the procedure's medical necessity, as well as the following items, which will help in the event of a denial. The physician should comment on the type of anesthesia used (namely local), the approach used (namely transnasal), and why the TNE was performed. For example, the patient had laryngopharyngeal reflux with fear of Barrett's esophagitis, esophageal ulceration, or possibly even esophageal malignancy. Following this, the physician  must comment on all findings, including those in the larynx,the esophagus, possibly the stomach, and the GE junction. He should also note whether a hiatal hernia is present. And if he performs a biopsy, he should indicate whether it was a brush biopsy or a regular biopsy.