How To Use CPT Code 43121

CPT 43121 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 43121?

CPT 43121 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, with or without the removal of the proximal part of the stomach. The surgeon performs a thoracotomy, which is an incision in the chest, to access the esophagus and perform the necessary resection. The remaining stomach is then reattached to the remaining esophagus, and a pyloroplasty may be performed to widen the opening at the bottom of the stomach.

2. Official Description

The official description of CPT code 43121 is: ‘Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty.’

3. Procedure

1. The surgeon makes an incision in the chest, typically between the sixth and seventh ribs, to access the esophagus.
2. The diseased portion of the esophagus is identified and cut free from its supports.
3. The esophagus is divided to begin the removal of the distal two-thirds.
4. If necessary, the surgeon may also remove a portion of the proximal stomach along with the esophagus.
5. The remaining stomach is positioned into the chest and connected to the remaining esophagus.
6. A pyloroplasty may be performed to widen the opening at the bottom of the stomach.
7. The surgeon inspects the surgical site for any leaks and closes the incision in layers.
8. Chest tubes may be placed to drain fluids during the healing process.

4. Qualifying circumstances

CPT 43121 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 surgeon and may involve the removal of the proximal part of the stomach. The patient must meet the specific criteria for the procedure, as determined by the surgeon.

5. When to use CPT code 43121

CPT code 43121 should be used when a partial esophagectomy is performed, specifically involving the distal two-thirds of the esophagus. The procedure must be performed with a thoracotomy approach and may or may not include the removal of the proximal part of the stomach. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT code 43121, the following documentation is required:

• Patient’s diagnosis necessitating the partial esophagectomy
• Details of the procedure, including the use of a thoracotomy approach and any additional procedures performed
• Extent of the esophageal resection and any removal of the proximal stomach
• Description of any additional procedures, such as pyloroplasty
• Findings during the procedure, including any complications or unexpected findings
• Details of the closure of the incision and placement of chest tubes, if applicable
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT code 43121, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure must involve a partial esophagectomy of the distal two-thirds, with or without the removal of the proximal part of the stomach. It is also important to accurately document the details of the procedure to support the use of this code. Additionally, be aware of any specific billing guidelines or requirements from insurance providers or payers.

8. Historical information

CPT code 43121 was added to the Current Procedural Terminology system on January 1, 1995. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement.

9. Examples

1. A patient with esophageal cancer undergoes a partial esophagectomy, involving the removal of the distal two-thirds of the esophagus and the reattachment of the remaining stomach to the remaining esophagus.
2. A spontaneous rupture of the esophagus requires a partial esophagectomy, with the removal of the damaged portion and the reconnection of the remaining esophagus to the stomach.
3. A patient with severe damage to the esophagus from caustic fluid ingestion undergoes a partial esophagectomy, with the removal of the affected area and the reconstruction of the remaining esophagus.
4. A partial esophagectomy is performed to remove a tumor in the distal two-thirds of the esophagus, with the reattachment of the remaining stomach to the remaining esophagus.
5. A patient with a history of esophageal disease undergoes a partial esophagectomy, with the removal of the distal two-thirds of the esophagus and the reconstruction of the remaining esophagus.
6. A partial esophagectomy is performed to remove a cancerous lesion in the distal two-thirds of the esophagus, with the reattachment of the remaining stomach to the remaining esophagus.