Medical Codes to Document Esophageal Cancer – An Overview

Medical Codes to Document Esophageal Cancer – An Overview

Esophageal cancer is cancer that occurs in the esophagus.

Read more about the symptoms, treatment options and medical codes for documenting this condition.

Esophageal cancer refers to a malignant tumor that forms in the tissues of the esophagus – a long, hollow tube that lies behind the trachea (windpipe) and in front of the spine, and connects the throat to the stomach. Food and liquids that are swallowed travel through the inside of the esophagus (called the lumen) to reach the stomach to be digested. This type of cancer usually occurs when the cells in your esophagus develop errors (mutations) in their DNA and these errors make the cells grow and divide out of control. The accumulating abnormal cells happen to form a tumor in the esophagus and grow larger to invade nearby structures and spread to other parts of the body. Typical signs and symptoms of esophageal cancer are weight loss and pain or difficulty in swallowing. Smoking, heavy alcohol use and Barrett esophagus can increase the risk of developing this condition. If left untreated, this condition can advance to a higher stage and cause several complications like severe pain, obstruction of the esophagus (making it difficult or impossible for food and liquid to pass through your esophagus) and sudden bleeding in the esophagus. Treatment options for esophageal cancer include – chemotherapy, radiation therapy, and surgery. Oncologists or other specialists treating this condition can depend on reliable medical billing companies to meet their claim submission tasks and thus receive correct reimbursement on time.

Regarded as the sixth most common cause of cancer deaths worldwide, esophageal cancer mostly occurs in men (than women) aged 60 years and above. Reports from the American Cancer Society (2019 statistics) suggest that there are about 17,650 new esophageal cancer cases diagnosed (13,750 in men and 3,900 in women) in the US. In addition, about 16,080 deaths (13,020 in men and 3,060 in women) occur from this type of cancer. Incidence rates vary within different geographic locations.

Types of Esophageal Cancer and Symptoms Esophageal cancer is generally classified according to the type of cells that are involved.

The types of cancer that occur help you determine the correct treatment modalities. Types of esophageal cancer include – 

Adenocarcinoma – One of the most common forms of esophageal cancer in the US, this condition most often occurs in the cells of mucus-secreting glands in the esophagus.

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Squamous cell carcinoma - The squamous cells are flat, thin cells that line the surface of the esophagus. This condition occurs most often in the upper and middle portions of the esophagus.

Other rare types of esophageal cancer include - small cell carcinoma, sarcoma, lymphoma, melanoma and choriocarcinoma.

Early stage esophageal cancer typically causes no signs or symptoms. In most cases, the symptoms normally arise when the disease has reached a more advanced stage. Common signs and symptoms include 

Difficulty swallowing (dysphagia)

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Weight loss without trying

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Chest pain, pressure or burning

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Worsening indigestion or heartburn

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Coughing or hoarseness

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Vomiting

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Voice changes

Treating Esophageal Cancer – What Are the Options?

For patients who experience any of the above-mentioned symptoms, it is important to consult an oncologist specialist. These specialists will initially conduct an endoscopy to examine the esophagus in detail and look for any cancerous cells or other areas of irritation. In some cases, biopsy will be done wherein the samples of suspicious tissue will be sent to a laboratory to check for cancer cells.

Once a diagnosis of esophageal cancer is confirmed, physicians will suggest certain other additional tests like – Endoscopic ultrasound (EUS), Barium Swallow test, Computerized tomography (CT) and Positron emission tomography (PET) in order to determine whether the tumor has spread to lymph nodes or to other areas of your body. The results of these tests are used to determine the specific stage of the disease- whether the disease is in its early stages or has advanced and has spread to other areas of the body.

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Treatment options for this condition may depend on the types of cells involved in your cancer, stage of cancer and overall health of the patient. Common treatment options include –chemotherapy, radiation therapy and a combination of these two therapies.

Surgical interventions may also be done to treat people with esophageal cancer. These surgical techniques include – Esophagectomy (surgeon removes part of the esophagus) and Esophagogastrectomy (surgeon removes the part of the esophagus with the tumor, as well as parts of the stomach and nearby lymph nodes).

Applicable ICD-10 and CPT Codes Radiology medical billing and coding is quite complex as it involves using the numerous codes for reporting this condition on your medical claims. Medical codes to report esophageal cancer include – ICD-10 Codes 

C15 - Malignant neoplasm of esophagus

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C15.3 - Malignant neoplasm of upper third of esophagus

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C15.4 - Malignant neoplasm of middle third of esophagus

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C15.5 - Malignant neoplasm of lower third of esophagus

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C15.8 - Malignant neoplasm of overlapping sites of esophagus

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C15.9 - Malignant neoplasm of esophagus, unspecified

CPT Codes 

43191 - Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)

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43193 - Esophagoscopy, rigid, transoral; with biopsy, single or multiple

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43194 - Esophagoscopy, rigid, transoral; with removal of foreign body(s)

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43195 - Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter)

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43196 - Esophagoscopy, rigid, transoral; with insertion of guide wire followed by dilation over guide wire

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43197 - Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

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43198 - Esophagoscopy, flexible, transnasal; with biopsy, single or multiple

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43200 - Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

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43202 - Esophagoscopy, flexible, transoral; with biopsy, single or multiple

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43213 - Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (includes fluoroscopic guidance, when performed)

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43214 - Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or larger) (includes fluoroscopic guidance, when performed)

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43215 - Esophagoscopy, flexible, transoral; with removal of foreign body(s)

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43216 - Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

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43217 - Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

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43220 - Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter)

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43226 - Esophagoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) over guide wire

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43229 - Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

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43231 - Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination

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43239 - Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple

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43247 - Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s)

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43250 - Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

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It is important to seek emergency help if the patient experiences any typical symptoms of esophageal cancer like sudden weight loss or difficulty in swallowing. People can reduce the potential risks of this type of cancer in the long run by maintaining healthy lifestyle habits like – increasing the intake of fruits and vegetables in their diet, maintaining a healthy body weight, quitting smoking and intake of alcohol.

Medical billing and coding requires comprehensive knowledge regarding appropriate coding modifiers and payer-specific guidelines to ensure correct and on-time reimbursement. The support of a reliable and experienced medical coding company could prove useful for reporting esophageal cancer correctly.

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