CPT® Code 43256

Code deleted, see 43266

Official Description

Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement (includes predilation)

Common Language Description

The procedure described by CPT® Code 43256 involves an upper gastrointestinal endoscopy, which is a minimally invasive diagnostic and therapeutic procedure used to examine the upper digestive tract, including the esophagus, stomach, and either the duodenum and/or jejunum. This procedure is particularly indicated for treating stenosis, which refers to the narrowing of the upper digestive tract that can lead to difficulties in swallowing and other gastrointestinal symptoms. During the procedure, the patient is typically administered a local anesthetic spray to numb the mouth and throat, facilitating the insertion of a flexible fiberoptic endoscope. This endoscope is a thin, tube-like instrument equipped with a light and camera that allows for direct visualization of the upper gastrointestinal structures. As the patient swallows, the endoscope is carefully advanced through the mouth and throat, guided by the physician's direct visualization. The esophagus is thoroughly inspected for any abnormalities, followed by the stomach, which is insufflated with air to enhance visibility. The various regions of the stomach, including the cardia, fundus, greater and lesser curvature, and antrum, are examined for any pathological changes. The endoscope is then advanced through the pylorus into the duodenum and/or jejunum, where the mucosal surfaces are inspected. In cases where stenosis is identified, the procedure includes the dilation of the narrowed area to alleviate obstruction. Following this, a stent, which is a small tube designed to keep the passage open, is selected based on the size of the stenosis and is introduced through the endoscope. The stent is then positioned and deployed within the narrowed segment of the upper digestive tract. To ensure proper placement and expansion of the stent, separate radiographs are obtained, which are crucial for confirming that the stent is functioning as intended within the gastrointestinal tract.

1. Indications

The procedure described by CPT® Code 43256 is indicated for the treatment of stenosis in the upper digestive tract. The following conditions may warrant the performance of this procedure:

Stenosis of the Esophagus - Narrowing of the esophagus that can lead to swallowing difficulties.
Stenosis of the Stomach - Narrowing within the stomach that may obstruct the passage of food.
Stenosis of the Duodenum and/or Jejunum - Narrowing in the small intestine that can affect digestion and nutrient absorption.

2. Procedure

The procedure involves several key steps to ensure effective treatment of the stenosis:

Preparation and Anesthesia - The patient is prepared for the procedure, and a local anesthetic spray is applied to numb the mouth and throat, minimizing discomfort during the insertion of the endoscope.
Insertion of the Endoscope - A hollow mouthpiece is placed in the patient's mouth to facilitate the insertion of the flexible fiberoptic endoscope. The endoscope is then carefully advanced as the patient swallows, allowing for smooth passage through the upper digestive tract.
Visualization and Inspection - Once the endoscope passes beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected for any abnormalities, followed by the stomach, which is insufflated with air to enhance visibility. The cardia, fundus, greater and lesser curvature, and antrum of the stomach are thoroughly examined.
Advancement to the Duodenum and/or Jejunum - The tip of the endoscope is advanced through the pylorus into the duodenum and/or jejunum, where the mucosal surfaces are inspected for any pathological changes.
Dilation of Stenosis - The area of stenosis is identified, and if necessary, it is dilated to alleviate the narrowing and improve passage.
Stent Selection and Placement - The position and length of the stenosis are determined, and an appropriately sized stent is selected. The stent is then introduced through the endoscope and positioned in the narrowed portion of the upper digestive tract before being deployed (expanded) to maintain patency.
Post-Procedure Imaging - Separate radiographs are obtained to evaluate the expansion of the stent and ensure that it is properly placed within the upper digestive tract.

3. Post-Procedure

After the procedure, patients may be monitored for any immediate complications or adverse reactions to the anesthesia. It is important to assess the effectiveness of the stent placement and ensure that the patient can swallow without difficulty. Follow-up care may include dietary modifications and instructions on signs of potential complications, such as pain, bleeding, or infection. The healthcare provider will typically schedule a follow-up appointment to evaluate the patient's recovery and the functionality of the stent.

Short Descr	UPPR GI ENDOSCOPY W/STENT
Medium Descr	UPR GI NDSC TNDSC STENT PLMT W/PREDILAT
Long Descr	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with transendoscopic stent placement (includes predilation)
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	3 - Special rules for multiple endoscopic procedures apply...
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Endoscopic Base Code	43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Procedure or Service, Multiple Reduction Applies
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	70 - Upper gastrointestinal endoscopy, biopsy