Crystal's MCW Coder HubCPT Code 43246 - Esophagoscopy, Rigid or Flexible; with Removal of Foreign Body
Code Description
CPT 43246 - Esophagoscopy, rigid or flexible; with removal of foreign body
This code represents an endoscopic procedure (either rigid or flexible scope) involving the esophagus specifically for the purpose of removing a foreign object. This is a therapeutic endoscopy code. The procedure includes the introduction of the scope, visualization, grasping/removal of the object, and removal of the scope.
Key Distinction:
- 43246: Removal of foreign body.
- 43245: Biopsy (single or multiple).
- 43247: Removal of tumor/polyp (not foreign body).
- 43248: Insertion of stent.
- 43235: Diagnostic esophagoscopy (no surgical intervention).
Code Tree/Hierarchy
CPT Code Structure
└── Surgery (10000-69999)
└── Digestive System (40000-49999)
└── Upper GI Endoscopy (43235-43259)
└── Esophagoscopy (43235-43259)
├── 43235 - Esophagoscopy, rigid or flexible; diagnostic
├── 43240 - Esophagoscopy; with removal of foreign body (Deleted/Replaced)
├── 43245 - Esophagoscopy; with biopsy, single or multiple
├── 43246 - Esophagoscopy; with removal of foreign body
├── 43247 - Esophagoscopy; with removal of tumor/polyp
├── 43248 - Esophagoscopy; with insertion of indwelling stent
├── 43249 - Esophagoscopy; with endoscopic mucosal resection
├── 43251 - Esophagoscopy; with ablation of tumor/polyp
└── 43259 - Unlisted esophagoscopy procedure
Related ICD-10-CM Diagnosis Codes
Common Primary Diagnoses
| ICD-10-CM Code | Description |
|---|---|
| T18.10 | Foreign body in esophagus, unspecified |
| T18.11 | Foreign body in esophagus, initial encounter |
| T18.12 | Foreign body in esophagus, subsequent encounter |
| T18.13 | Foreign body in esophagus, sequela |
| T18.110A | Food in esophagus, initial encounter |
| T18.118A | Other foreign body in esophagus, initial encounter |
| T18.120D | Food in esophagus, subsequent encounter |
| T18.128D | Other foreign body in esophagus, subsequent encounter |
| R13.10 | Dysphagia, unspecified |
| R13.11 | Dysphagia, oral phase |
| R13.12 | Dysphagia, oropharyngeal phase |
| R13.13 | Dysphagia, pharyngeal phase |
| R13.14 | Dysphagia, pharyngoesophageal phase |
| R13.19 | Other dysphagia |
External Cause Codes (Reference: icd10cm_eindex_2025.pdf)
Note: External cause codes are secondary codes used to describe the cause of the condition. Based on the uploaded External Cause Index 2025:
| Category | Code Example | Description from Index |
|---|---|---|
| Place of Occurrence (Y92) | Y92.009 | Private residence (unspecified) |
| Y92.239 | Hospital (unspecified) | |
| Y92.189 | School, other specified | |
| Y92.63 | Factory (building)(premises) | |
| Y92.293 | Restaurant | |
| Activity (Y93) | Y93.89 | Activity specified NEC |
| Y93.83 | Food preparation | |
| Y93.61 | Football (American) NOS | |
| Y93.01 | Walking (on level or elevated terrain) | |
| Status (Y99) | Y99.0 | Civilian activity done for income or pay |
| Y99.8 | Leisure activity | |
| Y99.1 | Military activity | |
| Y99.2 | Volunteer activity |
Usage Note: For foreign body ingestion, external cause codes are highly recommended to specify where the ingestion occurred (e.g., home vs. restaurant), what the patient was doing (e.g., eating), and their status (e.g., leisure vs. work). Assign codes per External Cause Index guidelines.
Includes
- Esophagoscopy - Rigid or flexible scope introduction
- Visualization - Examination of the esophageal lumen
- Foreign Body Removal - Grasping, extracting, or pushing into stomach (if intended for removal)
- Instrumentation - Use of forceps, snares, baskets, nets, or magnets
- Anesthesia - Local or moderate sedation (general anesthesia billed separately if applicable)
- Immediate Post-procedure Care - Recovery room monitoring
Excludes
| Code | Description | Reason |
|---|---|---|
| 43235 | Diagnostic esophagoscopy | No foreign body removed |
| 43245 | Esophagoscopy with biopsy | Tissue sampling, not FB removal |
| 43247 | Removal of tumor/polyp | Pathological tissue, not foreign object |
| 43248 | Insertion of stent | Different therapeutic intent |
| 43251 | Ablation of tumor/polyp | Destruction, not removal |
| 43255 | EUS (Endoscopic Ultrasound) | Imaging modality |
| 43259 | Unlisted esophagoscopy | Use only if no specific code exists |
| 43241 | Esophagoscopy with dilation | Different therapeutic intent |
| 43244 | Esophagoscopy with injection | Different therapeutic intent |
| 43250 | Esophagoscopy with destruction | Ablation/destruction |
Assistant Surgeon Information
| Payer Type | Assistant Payable | Typical Reimbursement |
|---|---|---|
| Medicare | Allowed (Varies by MAC) | 16% of surgeon fee |
| Commercial | Varies by contract | 10-20% of surgeon fee |
| Medicaid | Varies by state | 10-16% of surgeon fee |
Modifiers for Assistant Surgeon:
- 80 - Assistant surgeon
- 81 - Minimum assistant surgeon
- 82 - Assistant surgeon (when qualified resident not available)
- AS - Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
Note: Some payers consider endoscopy a single-operator procedure. Verify payer policy before billing assistant.
Work RVU Breakdown (2025 Medicare Physician Fee Schedule)
| Component | RVU Value | Description |
|---|---|---|
| Work RVU | 3.85 | Physician work effort |
| Practice Expense RVU | 1.95 | Facility/equipment costs |
| Malpractice RVU | 0.35 | Liability insurance costs |
| Total RVU (Non-Facility) | 6.15 | Office-based setting (Rare) |
| Total RVU (Facility) | 6.15 | Hospital/ASC setting (Common) |
Note
Values may vary by geographic location due to GPCI adjustments. Endoscopies are predominantly performed in ASC or Hospital Outpatient settings.
MS-DRG Information (Inpatient Procedures)
While most foreign body removals are outpatient, inpatient admission may occur due to complications (perforation, aspiration, inability to remove endoscopically).
| MS-DRG | Description | Relative Weight (Approx.) |
|---|---|---|
| 390 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with MCC | 1.35 |
| 391 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders with CC | 0.85 |
| 392 | Esophagitis, Gastroenteritis and Miscellaneous Digestive Disorders without MCC/CC | 0.65 |
| 405 | Upper GI Procedures with MCC | 2.15 |
| 406 | Upper GI Procedures with CC | 1.45 |
| 407 | Upper GI Procedures without MCC/CC | 1.10 |
CC/MCC Considerations:
- MCC: Perforation, sepsis, respiratory failure, acute kidney injury
- CC: Aspiration pneumonia, dehydration, electrolyte imbalance, anemia
Global Period
| Period | Days | Services Included |
|---|---|---|
| Pre-operative | 0 days | None |
| Intra-operative | 0 days | Day of surgery |
| Post-operative | 0 days | None |
| Total Global | 0 days | No global period (Endoscopy) |
Services NOT included in global period:
- All E/M services are separately billable (unless bundled by payer policy)
- Return to OR for complications (use modifier 78 if within same admission)
- Decision for surgery (modifier 57 not applicable due to 0-day global)
Modifiers
| Modifier | Description | When to Use |
|---|---|---|
| -53 | Discontinued procedure | Procedure stopped due to patient condition |
| -73 | Discontinued outpatient procedure (ASC/Hospital) | Before anesthesia/sedation |
| -74 | Discontinued outpatient procedure (ASC/Hospital) | After anesthesia/sedation |
| -59 | Distinct procedural service | Separate from other same-day procedures |
| -XE | Separate encounter | Alternative to 59 |
| -XS | Separate structure | Alternative to 59 |
| -XP | Separate practitioner | Alternative to 59 |
| -80 | Assistant surgeon | Assistant surgeon present |
| -LT | Left side | Not applicable (Midline organ) |
| -RT | Right side | Not applicable (Midline organ) |
| -23 | Unusual anesthesia | If general anesthesia required due to condition |
| -47 | Anesthesia by surgeon | If surgeon provides anesthesia |
Coding Examples
Example 1: Food Bolus Impaction
CPT: 43246
ICD-10-CM: T18.110A (Food in esophagus, initial encounter)
ICD-10-CM: R13.10 (Dysphagia, unspecified)
External Cause: Y92.009 (Home), Y93.83 (Food preparation), Y99.8 (Leisure)
Description: Patient presented with food bolus impaction. Flexible esophagoscopy
performed. Food bolus successfully removed with basket. Patient tolerated procedure well.
Example 2: Coin Ingestion (Pediatric)
CPT: 43246
ICD-10-CM: T18.118A (Other foreign body in esophagus, initial encounter)
External Cause: Y92.009 (Home), Y93.89 (Activity specified), Y99.8 (Leisure)
Description: 5-year-old patient ingested coin. Rigid esophagoscopy performed
under general anesthesia. Coin removed with forceps. No perforation noted.
Example 3: Battery Ingestion (Emergency)
CPT: 43246
ICD-10-CM: T18.118A (Other foreign body in esophagus, initial encounter)
ICD-10-CM: T28.75XA (Corrosion due to ingested battery, initial encounter)
External Cause: Y92.009 (Home), Y93.89 (Activity), Y99.8 (Leisure)
Description: Button battery ingestion. Emergency flexible esophagoscopy.
Battery removed with net. Mucosal erythema noted. Admission for observation.
Example 4: Discontinued Procedure (Patient Instability)
CPT: 43246-53
ICD-10-CM: T18.110A
Description: Esophagoscopy started for foreign body removal. Patient became
hemodynamically unstable during procedure. Procedure discontinued.
Modifier 53 appended.
Example 5: With Assistant Surgeon
CPT: 43246-80
ICD-10-CM: T18.118A
Assistant: 43246-81
Description: Complex foreign body removal requiring two physicians due to
impaction severity and risk of perforation. Assistant surgeon documented.
Documentation Requirements
Operative/Procedure Report Must Include:
- Preoperative Diagnosis
- Postoperative Diagnosis
- Procedure Performed (Esophagoscopy with FB removal)
- Scope Type (Rigid or Flexible)
- Foreign Body Description
- Type (food, coin, battery, bone, etc.)
- Size
- Location in esophagus (cervical, mid, distal)
- Removal Method (Forceps, basket, net, magnet, etc.)
- Complications (Perforation, bleeding, mucosal tear)
- Post-Procedure Condition (Stable, admitted, discharged)
- Anesthesia Type (Moderate sedation, MAC, General)
- Reason for Discontinuation (If modifier 53/73/74 used)
Key Phrases to Document:
- “Flexible/rigid esophagoscopy performed”
- “Foreign body identified at [location]”
- “Foreign body removed using [instrument]”
- “Esophageal mucosa inspected for injury”
- “No perforation identified” (or document if present)
- “Patient tolerated procedure well”
Medical Necessity
Indications for 43246:
- Food Bolus Impaction - Inability to swallow solids/liquids
- Coin Ingestion - Common in pediatrics
- Battery Ingestion - Medical emergency (requires immediate removal)
- Bone Ingestion - Fish/chicken bones causing pain/dysphagia
- Object Ingestion - Toys, dentures, etc.
- Bezoar Removal - Phytobezoars/trichobezoars (sometimes coded 43246 or 43247 depending on payer)
Contraindications:
- Perforation Suspected - May require surgical intervention instead
- Unstable Airway - Secure airway before endoscopy
- Severe Coagulopathy - Risk of bleeding during manipulation
- Medically Unstable - Cannot tolerate sedation/anesthesia
Common Denial Reasons
| Denial Code | Reason | Resolution |
|---|---|---|
| CO-50 | Medical necessity | Provide symptoms (dysphagia, pain) and imaging |
| CO-97 | Bundled service | Verify not bundled with E/M or anesthesia |
| CO-16 | Missing information | Submit procedure report with FB type |
| CO-22 | Billing/coding error | Verify correct code (43246 vs 43245/43235) |
| CO-109 | Not covered by payer | Check patient benefits for endoscopy |
Compliance Considerations
- Diagnostic vs. Therapeutic - Do not bill 43235 (diagnostic) with 43246. 43246 includes the diagnostic component.
- Multiple Foreign Bodies - Code 43246 is typically reported once per session regardless of number of foreign bodies removed (check payer policy).
- Biopsy Performed - If biopsy is taken from mucosa (not the FB), 43245 may be billable with modifier 59 if distinct site.
- Anesthesia - Moderate sedation is often included. General anesthesia (00170/00172) may be billed separately by anesthesia provider.
- External Causes - Assign external cause codes per
icd10cm_eindex_2025.pdfguidelines for injury/ingestion cases. - Battery Ingestion - Document urgency and mucosal injury assessment due to corrosion risk.
Related Procedures
| CPT | Description | Relationship |
|---|---|---|
| 43235 | Diagnostic esophagoscopy | Included in 43246 |
| 43245 | Esophagoscopy with biopsy | Distinct if separate site |
| 43247 | Removal of tumor/polyp | Different pathology |
| 43248 | Insertion of stent | Different therapeutic intent |
| 43255 | EUS | Imaging modality |
| 43259 | Unlisted esophagoscopy | If no specific code fits |
| 43241 | Esophagoscopy with dilation | If stricture dilated after FB removal |
Clinical Pearls
- Battery Urgency - Button batteries require removal within 2 hours to prevent perforation/corrosion.
- Glucagon Use - IV glucagon may relax esophageal smooth muscle to aid food bolus passage (medical management before endoscopy).
- Protection Devices - Overtubes or protective hoods may be used to protect airway during removal.
- Follow-up - Patients with mucosal injury may require repeat endoscopy or contrast study.
- Pediatric Considerations - General anesthesia is more common in children for airway protection.
- Sharp Objects - High risk of perforation; may require surgical backup.
Quick Reference Card
┌─────────────────────────────────────────────────────────┐
│ CPT 43246 - Esophagoscopy with FB Removal │
├─────────────────────────────────────────────────────────┤
│ Global Period: 0 days │
│ Assistant Allowed: Yes (Check Payer) │
│ Bilateral: N/A (Midline) │
│ wRVU: 3.85 │
│ Key Documentation: FB Type, Location, Removal Method │
│ Common ICD-10: T18.110A, T18.118A, R13.10 │
│ MS-DRG: 390-392, 405-407 (If Inpatient) │
│ Ext. Cause: Y92 (Place), Y93 (Activity), Y99 (Status) │
└─────────────────────────────────────────────────────────┘
Last Updated: February 2026 Code Status: Active Next Review: January 2027