Thursday, February 10, 2011

CPT code 91111 - Esophageal Varices

Treatment/Application Guidelines:

    Endoscopy by Capsule of the Esophagus - CPT 91111 
 .    E
sophageal Varices 
Treatment with beta-blockers or variceal ligation is generally accepted to reduce the incidence of first bleeding in patients with medium to large varices. Consequently, triage of cirrhotics into those with medium-large varices or none-small varices is reasonable to determine who should be treated. 

*    Capsule endoscopy of the esophagus is an alternative to conventional endoscopy in cirrhotic patients who are anticipated to tolerate adequate doses of beta-blockers. 

*   Evaluation for esophageal varices is reasonable in patients with cirrhosis and portal hypertension and no prior variceal bleeding. Cirrhosis and portal hypertension is defined for this policy as a Child's class B or C stage or a class A with a low platelet count (less than 140,000), an enlarged portal vein diameter (greater than 13 mm), or evidence of collateral circulation on ultrasound.

This test is not covered for any other purpose, including GERD evaluation.

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