How To Use CPT Code 43118

CPT 43118 describes a surgical procedure known as partial esophagectomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43118?

CPT 43118 is a code used to describe a surgical procedure called partial esophagectomy. This procedure involves the removal of the distal two-thirds of the esophagus, along with a possible removal of the upper part of the stomach. The esophagus is then replaced with a segment of the colon or small bowel. The surgery requires both abdominal and chest incisions.

2. Official Description

The official description of CPT code 43118 is: ‘Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es).’ This code should be used when the provider performs a partial esophagectomy, removing the distal two-thirds of the esophagus, with or without removal of the proximal part of the stomach. The procedure involves replacing the esophagus with a segment of the colon or small bowel, including the mobilization, preparation, and anastomosis of the intestine(s).

3. Procedure

1. The surgeon begins by making incisions in the abdomen and chest, typically between the sixth and seventh ribs.
2. They identify the diseased portion of the esophagus and cut it free from its supports.
3. The esophagus is divided to begin the removal of the distal two-thirds.
4. Through the separate incision in the abdomen, the surgeon assesses the stomach and distal esophagus.
5. They may remove a portion of the proximal stomach along with the esophagus, or divide the esophagus where it meets the stomach.
6. A segment of the colon or small bowel is identified and freed from its attachments.
7. The proximal and distal ends of the segment are divided from the rest of the intestines.
8. The surgeon carefully preserves the blood supply to this bowel segment.
9. An anastomosis is performed to maintain bowel continuity.
10. The bowel graft is positioned in the chest and connected to the remaining esophagus and the stomach, creating a new esophagus.
11. Air or dye may be used to check for leaks at the anastomotic sites.
12. The wounds are inspected and closed in layers.

4. Qualifying circumstances

CPT 43118 is used for patients who require a partial esophagectomy, typically due to conditions such as esophageal cancer, severe damage from caustic fluids, or spontaneous ruptures of the esophagus. The procedure is performed by a qualified surgeon and may involve the removal of the proximal part of the stomach. The replacement of the esophagus with a segment of the colon or small bowel, including the mobilization, preparation, and anastomosis of the intestine(s), is also included in this code.

5. When to use CPT code 43118

CPT code 43118 should be used when a partial esophagectomy is performed, removing the distal two-thirds of the esophagus, with or without removal of the proximal part of the stomach. The procedure involves replacing the esophagus with a segment of the colon or small bowel, including the mobilization, preparation, and anastomosis of the intestine(s). This code should not be used for total esophagectomy with gastropharyngostomy or esophagogastrectomy with vagotomy, as separate codes exist for these procedures.

6. Documentation requirements

To support a claim for CPT 43118, the surgeon must document the following information:

• Patient’s diagnosis necessitating the partial esophagectomy
• Details of the procedure, including the specific segments of the esophagus and stomach removed
• Description of the colon or small bowel segment used for replacement
• Date of the surgery
• Start and end times of the procedure
• Any complications or additional procedures performed
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 43118, ensure that the procedure meets the criteria outlined in the official description. The surgeon should make the necessary incisions, remove the specified portions of the esophagus and stomach, and perform the replacement with a segment of the colon or small bowel. It is important to follow the guidelines for documentation and include all required information on the claim form. CPT code 43118 should not be reported with other codes for total esophagectomy or esophagogastrectomy procedures.

8. Historical information

CPT code 43118 was added to the Current Procedural Terminology system on January 1, 1995. There have been no updates or changes to the code since its addition. However, it is worth noting that this procedure is listed under the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient with esophageal cancer undergoes a partial esophagectomy, with removal of the distal two-thirds of the esophagus and a portion of the proximal stomach. The surgeon replaces the esophagus with a segment of the colon, performing the necessary mobilization, preparation, and anastomosis.