How To Use CPT Code 43112

CPT 43112 describes a specific surgical procedure known as total or near total esophagectomy with pharyngogastrostomy or cervical esophagogastrostomy. 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 43112?

CPT 43112 is a code used to describe a surgical procedure called total or near total esophagectomy with pharyngogastrostomy or cervical esophagogastrostomy. This procedure involves the removal of all or most of the esophagus and the attachment of the stomach to the pharynx or the cervical esophagus. It may also include pyloroplasty, which is the widening of the pyloric opening at the bottom of the stomach. This code is used to report the specific details of this surgical procedure.

2. Official Description

The official description of CPT code 43112 is: ‘Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (i.e., McKeown esophagectomy or tri-incisional esophagectomy).’ This code represents the surgical removal of the esophagus, with the attachment of the stomach to either the pharynx or the cervical esophagus, and the possibility of pyloroplasty.

3. Procedure

1. The surgical procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider makes an incision into the chest and explores the chest cavity.
3. Additional incisions are made in the neck and the abdomen.
4. The provider cuts the esophagus free of its supports, either in the neck or higher up where it begins at the pharynx.
5. An incision is made in the upper abdomen to visualize the stomach and the gastroesophageal (GE) junction.
6. The provider divides the esophagus from the stomach and removes the esophagus.
7. The stomach is pulled up into the chest and connected to the remaining cervical esophagus or the pharynx.
8. Pyloroplasty may be performed to widen the opening in the lower part of the stomach.
9. The provider checks for leaks at the anastomotic sites using air or dye.
10. The wound is inspected and closed in layers.
11. Chest tubes may be placed for drainage during healing.

4. Qualifying circumstances

CPT 43112 is used for patients who require total or near total esophagectomy with pharyngogastrostomy or cervical esophagogastrostomy. This procedure is typically performed to remove cancer of the esophagus, repair spontaneous ruptures of the esophagus, or remove areas of the esophagus that have been badly damaged by ingestion of caustic fluids. The procedure is performed by a qualified healthcare professional and may involve pyloroplasty to widen the pyloric opening.

5. When to use CPT code 43112

CPT code 43112 should be used when reporting a total or near total esophagectomy with pharyngogastrostomy or cervical esophagogastrostomy procedure. It is important to accurately document the details of the procedure and ensure that it meets the criteria outlined in the code description. This code should not be used for other types of esophageal surgeries or procedures.

6. Documentation requirements

To support a claim for CPT code 43112, the healthcare professional must document the following information:

• Patient’s diagnosis necessitating the esophagectomy
• Details of the procedure, including the specific approach used (e.g., McKeown esophagectomy or tri-incisional esophagectomy)
• Date of the procedure
• Start and end times of the procedure
• Any additional procedures performed, such as pyloroplasty
• Any complications or unexpected findings
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT code 43112, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed by a qualified healthcare professional and should include the necessary components, such as thoracotomy, pharyngogastrostomy or cervical esophagogastrostomy, and pyloroplasty if applicable. It is also important to follow any additional guidelines or requirements set forth by the payer or coding guidelines.

8. Historical information

CPT code 43112 was added to the Current Procedural Terminology system on January 1, 1995. The code underwent a change on January 1, 2018, with the description being modified to include the option of pyloroplasty. It is important to stay updated on any changes or revisions to the code to ensure accurate reporting.

9. Examples

1. A patient undergoes a total esophagectomy with pharyngogastrostomy for the treatment of esophageal cancer.
2. A patient requires a near total esophagectomy with cervical esophagogastrostomy due to severe damage to the esophagus from caustic fluid ingestion.
3. A total esophagectomy with pharyngogastrostomy and pyloroplasty is performed on a patient with a spontaneous rupture of the esophagus.
4. A near total esophagectomy with cervical esophagogastrostomy and pyloroplasty is performed to remove a large tumor in the esophagus.