Changes to CPT Esophagoscopy Definition in 2015

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March 12, 2015

Question:  

I did a direct laryngoscopy, bronchoscopy and esophagoscopy for tumor staging. Are all three codes billable?

Answer:

Yes, but make sure that you performed what CPT now says is included in the esophagoscopy. Effective 1/1/15, CPT added this guideline: “Esophagoscopy includes examination from the cricopharyngeus muscle (upper esophageal sphincter) to and including the gastroesophageal junction. It may also include examination of the proximal region of the stomach via retroflexion when performed.” This means you must look all the way down to the GE junction in order to separately report a code for the esophagoscopy. Be sure your documentation includes these anatomical landmarks as you’ll likely need to appeal with the operative note.

If you do not examine from the upper esophageal sphincter to the gastroesophageal junction, then you may not report a separate esophagoscopy code. Whatever examination you perform is included in the other CPT code(s) you bill.