Friday, January 14, 2011

43200, 43202: Two Possible CPT Options for TNE

If you're wondering how to code a transnasal esophagoscopy (TNE), read on and find out how:

Select one of two CPT codes, depending on whether the TNE involved a biopsy.For a TNE in which the otolaryngologist does not carry out a biopsy, report 43200.When the TNE involves a biopsy, report 43202.

You can expect more pay 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 (RVUs) in the office than in the facility --7.31 NF RVUs versus 2.99 RVUs.

Probable 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.

    Urge your otolaryngologist to document the procedure's medical necessity, as well as the following items, which will help in the wake of a denial. The physician should comment on the type of anesthesia used (nalely local), the approach used (namely transnasal), and why the TNE was performed. For instance, the patient had laryngopharyngeal reflux with fear of Barrett's esophagitis, esophageal ulceration, or possibly even esophageal malignancy. After this, the doctor 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 carries out a biopsy, he should point to whether it was a brush biopsy or a regular biopsy.

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