How To Use CPT Code 42955

CPT 42955 describes the creation of an artificial opening in the pharynx for long-term feeding. 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 42955?

CPT 42955 is used to describe the procedure in which a physician creates an artificial opening in the pharynx for long-term feeding. This involves creating an opening through the skin of the neck to insert an esophagostomy tube for feeding purposes.

2. Official Description

The official description of CPT code 42955 is: ‘Pharyngostomy (fistulization of pharynx, external for feeding)’. This procedure involves creating an artificial opening in the pharynx for long-term feeding.

3. Procedure

1. The physician begins by making an incision in the skin of the neck, creating access to the pharynx.
2. An artificial opening is then created in the pharynx, allowing for the insertion of an esophagostomy tube.
3. The esophagostomy tube is carefully inserted through the artificial opening and secured in place.
4. The physician ensures that the tube is properly positioned and functioning correctly for long-term feeding.
5. The incision in the skin is closed, and appropriate dressings are applied to promote healing.

4. Qualifying circumstances

CPT 42955 is performed when a patient requires long-term feeding and an artificial opening in the pharynx is necessary. This procedure is typically performed on patients who are unable to consume food orally due to various medical conditions or complications. The physician must determine the need for long-term feeding and the appropriateness of creating an artificial opening in the pharynx.

5. When to use CPT code 42955

CPT code 42955 should be used when a physician performs the procedure to create an artificial opening in the pharynx for long-term feeding. It is important to ensure that the patient meets the qualifying circumstances and that the procedure is medically necessary for their condition.

6. Documentation requirements

To support a claim for CPT 42955, the physician must document the following information:

• Patient’s medical condition necessitating long-term feeding
• Details of the procedure, including the incision, creation of the artificial opening, and insertion of the esophagostomy tube
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 42955, ensure that the procedure meets the qualifying circumstances and is medically necessary for the patient. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing. Additionally, consider any applicable modifiers or additional codes that may need to be reported in conjunction with CPT 42955.

8. Historical information

CPT 42955 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with severe dysphagia undergoes CPT 42955 to create an artificial opening in the pharynx for long-term feeding.
2. A cancer patient who is unable to eat orally due to treatment side effects receives CPT 42955 to facilitate long-term feeding.
3. An individual with a neurological disorder requiring long-term enteral nutrition undergoes CPT 42955 to create an artificial opening in the pharynx.
4. A patient with a congenital anomaly affecting their ability to swallow undergoes CPT 42955 to enable long-term feeding.
5. A critically ill patient in the intensive care unit receives CPT 42955 to establish a means of long-term enteral nutrition.
6. A patient with a severe throat injury undergoes CPT 42955 to create an artificial opening in the pharynx for long-term feeding.
7. An elderly individual with advanced dementia receives CPT 42955 to facilitate long-term feeding.
8. A patient with a history of head and neck cancer undergoes CPT 42955 to enable long-term enteral nutrition.
9. A child with a congenital disorder requiring long-term enteral nutrition receives CPT 42955 to create an artificial opening in the pharynx.
10. An individual with a progressive neuromuscular disease undergoes CPT 42955 to facilitate long-term feeding.