How To Use CPT Code 43020

CPT 43020 describes the procedure of esophagotomy, which involves making an incision in the neck to access the esophagus and remove a foreign body. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43020?

CPT 43020 is used to describe the surgical procedure known as esophagotomy. This procedure involves making an incision in the side of the neck to access the esophagus and remove a foreign body. It is typically performed when a patient has ingested or lodged a foreign object in their esophagus that cannot be removed through less invasive methods.

2. Official Description

The official description of CPT code 43020 is: ‘Esophagotomy, cervical approach, with removal of foreign body.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider makes a careful incision in the side of the neck to access the esophagus.
3. The underlying tissues are dissected with care to preserve critical structures such as blood vessels, nerves, trachea, and other nearby organs.
4. Using a scalpel, the provider enters the cervical esophagus and locates the foreign body.
5. The foreign body is removed using forceps or other appropriate instruments.
6. The provider then repairs the esophagus and closes the tissues in layers using sutures.

4. Qualifying circumstances

CPT 43020 is performed when a patient has a foreign body lodged in their esophagus that cannot be removed through less invasive methods. The procedure is typically reserved for cases where the foreign body poses a significant risk to the patient’s health and cannot be safely passed or removed using other techniques.

5. When to use CPT code 43020

CPT code 43020 should be used when a provider performs an esophagotomy procedure to remove a foreign body from the esophagus. It is important to ensure that the procedure meets the specific criteria outlined in the code description, including the cervical approach and removal of a foreign body.

6. Documentation requirements

To support a claim for CPT 43020, the provider must document the following information:

• Patient’s medical history and reason for the esophagotomy procedure
• Description of the foreign body and its location within the esophagus
• Details of the surgical approach, including the incision site and technique used
• Description of the foreign body removal process
• Repair of the esophagus and closure of tissues
• Any complications or additional procedures performed
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43020, it is important to ensure that the procedure meets the specific criteria outlined in the code description. Additionally, providers should follow any applicable coding guidelines and modifiers to accurately report the procedure. It is also important to review any payer-specific requirements or policies regarding reimbursement for esophagotomy procedures.

8. Historical information

CPT 43020 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 presents with severe dysphagia and imaging reveals the presence of a large foreign body in the cervical esophagus. The provider performs an esophagotomy to remove the foreign body and repairs the esophagus.
2. An elderly patient accidentally ingests a sharp object that becomes lodged in their esophagus. The provider performs an esophagotomy to safely remove the foreign body and repairs any damage to the esophagus.
3. A child swallows a small toy that becomes stuck in their esophagus. The provider performs an esophagotomy to remove the foreign body and ensures the esophagus is properly repaired.
4. A patient with a history of mental health issues ingests a toxic substance that becomes lodged in their esophagus. The provider performs an esophagotomy to remove the foreign body and takes necessary measures to protect the patient’s health.
5. A patient presents with persistent chest pain and difficulty swallowing. After further evaluation, a foreign body is identified in the esophagus. The provider performs an esophagotomy to remove the foreign body and addresses any underlying issues.