How To Use CPT Code 43123

CPT 43123 describes a surgical procedure that involves the partial removal of the esophagus and possibly the upper part of the stomach. 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 43123?

CPT 43123 is a code used to describe a surgical procedure that involves the partial removal of the esophagus and potentially the upper part of the stomach. This procedure may also include the use of a colon or small bowel segment to replace the removed section of the esophagus. It is typically performed to treat conditions such as esophageal cancer, severe damage from caustic fluids, or spontaneous ruptures of the esophagus.

2. Official Description

The official description of CPT code 43123 is: ‘Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es).’ This code encompasses the surgical removal of a portion of the esophagus, potential removal of the proximal stomach, and the use of a colon or small bowel segment to reconstruct the esophagus.

3. Procedure

1. The surgeon begins by making an incision in the abdomen or both the abdomen and chest to access the diseased portion of the esophagus.
2. After identifying the affected area, the surgeon removes the diseased portion of the esophagus and may also remove a part of the proximal stomach if necessary.
3. The surgeon then selects an appropriate segment of the colon or small bowel to serve as a replacement for the removed section of the esophagus.
4. The chosen intestinal segment is mobilized and carefully detached from its attachments while preserving its blood supply.
5. An anastomosis, or connection, is created between the remaining ends of the intestine to maintain bowel continuity.
6. The bowel graft is positioned between the remaining esophagus and stomach, and the surgeon connects them on each end.
7. The surgeon may perform tests, such as using air or dye, to check for any leaks at the anastomotic site.
8. Finally, the incision is closed in layers, and the wound is inspected for any complications.

4. Qualifying circumstances

CPT 43123 is typically performed on patients with 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 a portion of the esophagus, potential removal of the proximal stomach, and the use of a colon or small bowel segment for reconstruction.

5. When to use CPT code 43123

CPT code 43123 should be used when a partial esophagectomy is performed, either through a thoracoabdominal or abdominal approach, with or without proximal gastrectomy. The procedure may involve the use of a colon interposition or small intestine reconstruction, including the mobilization, preparation, and anastomosis of the intestine. It is important to accurately document the specific details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 43123, the surgeon must document the following information:

• Patient’s diagnosis and the need for the partial esophagectomy
• Details of the procedure, including the approach used (thoracoabdominal or abdominal), whether proximal gastrectomy was performed, and the type of reconstruction (colon interposition or small intestine reconstruction)
• Date of the procedure and the duration of the surgery
• Any additional procedures performed during the same surgical session
• Any complications or unexpected findings encountered during the procedure
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 43123, it is important to ensure that the documentation supports the use of this code. The procedure should be performed by a qualified surgeon and involve the partial removal of the esophagus, potential removal of the proximal stomach, and the use of a colon or small bowel segment for reconstruction. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines.

8. Historical information

CPT 43123 was added to the Current Procedural Terminology system on January 1, 1995. There have been historical changes to the code, including a code change in 2002 that modified the description of the procedure. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A surgeon performs a partial esophagectomy through an abdominal approach, with proximal gastrectomy, and uses a colon interposition for reconstruction.
2. A patient with esophageal cancer undergoes a thoracoabdominal partial esophagectomy, without proximal gastrectomy, and a small intestine reconstruction.