What Is CPT Code 43235 and Why Is It on My Bill?
Understand CPT Code 43235: what this key medical identifier means for your care and its presence on your healthcare bill.
Current Procedural Terminology (CPT) codes are a standardized system for describing medical services and procedures. These five-digit numeric codes provide a uniform language for healthcare providers and payers, streamlining communication and billing across the United States. This system ensures medical treatments and diagnostic services are consistently reported, aiding accurate documentation and claims processing. Understanding these codes helps individuals interpret their medical records and bills.
What CPT Code 43235 Represents
CPT code 43235 identifies an Esophagogastroduodenoscopy (EGD) that is diagnostic and includes biopsy collection. An EGD is an endoscopic procedure to visually examine the lining of the upper gastrointestinal tract, encompassing the esophagus, stomach, and the initial segment of the small intestine, known as the duodenum. “Diagnostic” means the procedure investigates symptoms, identifies abnormalities, or confirms a suspected condition. Biopsies are collected for detailed laboratory analysis. This code differentiates it from other EGD codes covering therapeutic interventions, such as polyp removal or stricture dilation, or EGDs performed without biopsy.
The Esophagogastroduodenoscopy Procedure
A diagnostic EGD with biopsy involves several steps, beginning with preparation. Patients receive instructions to fast for a specific period before the procedure, often avoiding food for about eight hours and clear liquids for at least two hours. Upon arrival, medication is administered intravenously for relaxation and sedation, often with a local anesthetic spray to minimize gagging. A mouth guard is placed to protect the patient’s teeth and the endoscope.
Once sedated, a thin, flexible tube called an endoscope is gently guided through the mouth into the esophagus, stomach, and duodenum. The endoscope has a camera that transmits images to a monitor, allowing the gastroenterologist to inspect the internal lining of these organs. Air is often introduced through the scope to expand the digestive tract, improving visibility. If suspicious areas are observed, small instruments passed through the endoscope collect tissue samples for biopsy.
After visual inspection and biopsy collection, the endoscope is carefully withdrawn. Patients are moved to a recovery area and monitored as sedation wears off. Common temporary sensations include a mild sore throat or bloating from the air introduced. Collected biopsy samples are sent to a pathology laboratory for analysis, which helps diagnose various conditions.
Interpreting CPT 43235 on Your Medical Bill
On a medical bill or Explanation of Benefits (EOB), CPT code 43235 represents the professional fee for the physician who performed the diagnostic EGD with biopsy. This charge covers the gastroenterologist’s expertise and time conducting the procedure and collecting samples.
Beyond the physician’s fee, an EGD bill often includes several other charges. You may see a facility fee, which covers the use of the hospital or outpatient center where the procedure took place, including equipment and nursing staff. There will also be a separate charge for anesthesia services, covering medications and the professional services of the anesthesiologist or certified registered nurse anesthetist (CRNA) who administered and monitored your sedation. Additionally, a pathology fee will appear for the laboratory analysis of biopsy samples. If you have questions about any charges associated with CPT code 43235 on your bill, contacting the provider’s billing department or your insurance company directly can provide clarification.