How To Use CPT Code 43135

CPT 43135 describes the surgical procedure known as diverticulectomy of the hypopharynx or esophagus, with or without myotomy, using a thoracic approach. This article will provide an overview of CPT code 43135, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples.

1. What is CPT Code 43135?

CPT 43135 is a code used to describe the surgical removal of a diverticulum from the hypopharynx or esophagus through a thoracotomy, which is an incision made in the chest. This procedure may also involve a myotomy, which is the cutting of muscle. It is important to note that for endoscopic diverticulectomy of the hypopharynx or cervical esophagus, a different code, 43180, should be used.

2. Official Description

The official description of CPT code 43135 is: ‘Diverticulectomy of hypopharynx or esophagus, with or without myotomy; thoracic approach.’ This code was added to the Current Procedural Terminology system on January 1, 1990. It is worth mentioning that in 2017, it was added under the Inpatient Only (IPO) list for Medicare.

3. Procedure

1. When performing CPT code 43135, the healthcare provider begins by preparing and anesthetizing the patient.
2. An incision is made in the chest, allowing the provider to access the area of the hypopharynx or esophagus with the diverticulum.
3. The provider may make an incision into a muscle to tighten it and prevent future formation of diverticula or to expose the diverticulum.
4. The diverticulum is then grasped and removed through methods such as oversewing or excision.
5. The provider proceeds to repair the hypopharynx or esophagus in layers.
6. The site is irrigated with an antibiotic solution, and the wound is closed in layers.

4. Qualifying circumstances

CPT code 43135 is used when a diverticulum is present in the hypopharynx or esophagus and requires surgical removal. A diverticulum is an abnormal pouch or sac that opens from a hollow organ, such as the intestines, bladder, esophagus, or another organ. The procedure is performed through a thoracic approach, which involves making an incision in the chest. It is important to note that for diverticulum removal through a cervical incision, a different code, 43130, should be used.

5. When to use CPT code 43135

CPT code 43135 should be used when a diverticulum is present in the hypopharynx or esophagus and requires surgical removal through a thoracic approach. It is important to ensure that the procedure performed matches the description provided by the code. If the diverticulum is removed through a cervical incision, a different code, 43130, should be used.

6. Documentation requirements

To support a claim for CPT code 43135, the healthcare provider must document the following information:

• Patient’s diagnosis indicating the presence of a diverticulum in the hypopharynx or esophagus
• Description of the procedure performed, including whether a myotomy was involved
• Date of the procedure
• Details of the surgical approach used (thoracic)
• Any additional relevant information, such as complications or additional procedures performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 43135, it is important to ensure that the procedure performed matches the description provided by the code. The provider should also consider any additional procedures or complications that may affect the billing. It is recommended to review the specific billing guidelines provided by the payer to ensure accurate reporting and reimbursement.

8. Historical information

CPT code 43135 was added to the Current Procedural Terminology system on January 1, 1990. It has not undergone any updates or changes since its addition. However, it is worth noting that in 2017, it was added under the Inpatient Only (IPO) list for Medicare, indicating that it is typically performed in an inpatient setting.

9. Examples

1. A patient undergoes diverticulectomy of the hypopharynx through a thoracic approach to remove a diverticulum causing swallowing difficulties.
2. A healthcare provider performs diverticulectomy of the esophagus with myotomy using a thoracic approach to address recurrent infections and discomfort.
3. A diverticulum in the hypopharynx is surgically removed through a thoracic approach to alleviate symptoms of regurgitation and aspiration.
4. A patient with a large diverticulum in the esophagus undergoes diverticulectomy with myotomy using a thoracic approach to prevent further complications.
5. A diverticulum in the hypopharynx is removed through a thoracic approach to relieve symptoms of dysphagia and improve swallowing function.
6. A healthcare provider performs diverticulectomy of the esophagus using a thoracic approach to address recurrent infections and improve the patient’s quality of life.