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The procedure described by CPT® Code 43458 involves the dilation of the esophagus using a balloon that has a diameter of 30 mm or larger, specifically aimed at treating achalasia. Achalasia is a disorder characterized by the inability of the esophageal sphincter muscles to relax, which leads to a blockage that prevents food and liquids from passing into the stomach. This condition can cause significant discomfort and difficulty swallowing. During the procedure, a balloon catheter is introduced through the mouth and navigated into the esophagus. Once in place, the balloon is inflated to widen the esophagus, thereby alleviating the obstruction caused by the spasming sphincter muscles. The inflation of the balloon is typically maintained for a brief duration, ranging from 30 seconds to 2 minutes, before it is deflated and removed. This intervention is performed under fluoroscopic guidance, which is a real-time imaging technique that allows the physician to visualize the esophagus and ensure proper placement and effectiveness of the dilation. The goal of this procedure is to improve the patient's ability to swallow and enhance their quality of life by relieving the symptoms associated with achalasia.
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The procedure is indicated for patients diagnosed with achalasia, a condition that results in the esophageal sphincter muscles being unable to relax, leading to a blockage in the esophagus. The following are specific indications for performing balloon dilation:
The procedure for balloon dilation of the esophagus is carried out as follows:
After the balloon dilation procedure, patients are typically monitored for a short period to assess for any immediate complications or adverse reactions. It is common for patients to experience some discomfort or a sensation of fullness in the esophagus following the procedure. Recovery time may vary, but many patients can resume normal activities within a day. Physicians may provide specific post-procedure care instructions, including dietary modifications and follow-up appointments to monitor the patient's progress and evaluate the effectiveness of the treatment. It is essential for patients to report any unusual symptoms, such as severe pain or difficulty swallowing, to their healthcare provider promptly.
| Short Descr | DILATE ESOPHAGUS | Medium Descr | DILAT ESOPH BALLOON 30 MM DIAM/> ACHALASIA | Long Descr | Dilation of esophagus with balloon (30 mm diameter or larger) for achalasia | Status Code | Active Code | Global Days | 000 - Endoscopic or Minor Procedure | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple 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. | 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 | 69 - Esophageal dilatation |
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