CPT® Code 43192

Esophagoscopy, rigid, transoral, is a diagnostic and therapeutic procedure that involves the use of a rigid endoscope to visualize the esophagus. This procedure is performed through the mouth and allows for a thorough examination of the esophagus, including the velopharyngeal closure, base of the tongue, and hypopharynx. During the esophagoscopy, the physician can observe vocal cord motion and evaluate the pharyngeal musculature. The endoscope is carefully advanced to the cricopharyngeus, where the patient may be asked to perform actions such as burping or swallowing to facilitate the passage of the scope. The procedure enables the physician to examine the entire length of the esophagus up to the gastroesophageal junction, allowing for the identification of any abnormalities. A significant aspect of this procedure is the directed submucosal injection(s) of various substances, which may include India ink, botulinum toxin, saline, epinephrine, or corticosteroids. These injections serve multiple purposes, such as delineating lesions for excision, elevating lesions for better visibility, or treating conditions like esophageal achalasia. The use of India ink, for instance, is particularly noted for its role in tattooing lesions prior to excision, while saline or epinephrine injections help separate the mucosal layer from the underlying muscle layer. Botulinum toxin is specifically utilized in the treatment of esophageal achalasia, targeting the esophageal sphincter to alleviate symptoms associated with this condition.