How To Use CPT Code 42894

CPT 42894 describes the resection of the pharyngeal wall requiring closure with a myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 42894?

CPT 42894 is a code used to describe a surgical procedure in which part of the pharyngeal wall or pyriform sinus is removed. The provider then closes the wound using a myocutaneous or fasciocutaneous flap, or a free muscle, skin, or fascial flap with microvascular anastomosis. This procedure is typically performed to treat certain conditions or diseases affecting the pharyngeal wall.

2. Official Description

The official description of CPT code 42894 is: ‘Resection of pharyngeal wall requiring closure with myocutaneous or fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular anastomosis.’

3. Procedure

1. The provider begins by making an incision on the patient’s neck and deepening it to access the pharyngeal wall.
2. Using a technique called pharyngectomy, the provider removes the entire wall of the pharynx while preserving the laryngeal anatomy.
3. Regional flaps, such as deltopectoral, pectoralis major, latissimus dorsi, or trapezius flaps, are used to repair the surgical wound while ensuring an adequate blood supply.
4. The surgical wound is thoroughly flushed and closed with interrupted sutures after achieving hemostasis.

4. Qualifying circumstances

CPT 42894 is typically performed on patients who require the resection of the pharyngeal wall due to certain conditions or diseases. This procedure may be necessary to treat conditions such as tumors or other abnormalities affecting the pharyngeal wall. The use of myocutaneous or fasciocutaneous flaps, or free muscle, skin, or fascial flaps with microvascular anastomosis, is required for closure of the surgical wound.

5. When to use CPT code 42894

CPT code 42894 should be used when a provider performs the resection of the pharyngeal wall and closure with a myocutaneous or fasciocutaneous flap, or a free muscle, skin, or fascial flap with microvascular anastomosis. This code should be used specifically for cases where this procedure is performed.

6. Documentation requirements

To support a claim for CPT code 42894, the provider must document the following information:

• Patient’s diagnosis necessitating the resection of the pharyngeal wall
• Specific flaps or techniques used for closure of the surgical wound
• Date of the procedure
• Details of the surgical technique and any additional procedures performed
• Any complications encountered during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 42894, ensure that the procedure meets the requirements outlined in the official description. It is important to accurately document the specific flaps or techniques used for closure of the surgical wound. Additionally, be aware of any specific guidelines or modifiers that may apply when reporting this code.

8. Historical information

CPT code 42894 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been several changes to the code, including updates to the description and the addition of notes regarding its use in combination with other procedures.

9. Examples

1. A patient undergoes resection of the pharyngeal wall with closure using a myocutaneous flap due to the presence of a tumor.
2. A provider performs the resection of the pharyngeal wall and closure with a fasciocutaneous flap to treat a congenital abnormality.
3. During a surgical procedure, the provider removes part of the pharyngeal wall and closes the wound using a free muscle flap with microvascular anastomosis.
4. A patient with a history of pharyngeal cancer undergoes resection of the pharyngeal wall and closure with a skin flap.
5. A provider performs the resection of the pharyngeal wall and closure with a fascial flap with microvascular anastomosis to treat a recurrent infection.
6. During a surgical procedure, the provider removes part of the pharyngeal wall and closes the wound using a myocutaneous flap with microvascular anastomosis.
7. A patient undergoes resection of the pharyngeal wall with closure using a free muscle flap due to the presence of a benign tumor.
8. A provider performs the resection of the pharyngeal wall and closure with a fasciocutaneous flap with microvascular anastomosis to treat a traumatic injury.
9. During a surgical procedure, the provider removes part of the pharyngeal wall and closes the wound using a myocutaneous flap to treat a chronic infection.
10. A patient with a history of pharyngeal cancer undergoes resection of the pharyngeal wall and closure with a fascial flap.