How To Use CPT Code 43180

CPT 43180 describes the procedure of rigid esophagoscopy with diverticulectomy of the hypopharynx or cervical esophagus, along with cricopharyngeal myotomy and repair. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43180?

CPT 43180 is a code used to describe a specific procedure known as rigid esophagoscopy with diverticulectomy of the hypopharynx or cervical esophagus. During this procedure, the provider performs an examination of the esophagus using a rigid endoscope inserted through the mouth. The diverticulum, which is an abnormal pouch in the wall of the hypopharynx or cervical esophagus, is excised. Additionally, the provider performs a cricopharyngeal myotomy, which involves making an incision in the cricopharyngeus muscle. If necessary, repair is also performed. It is important to note that this procedure should not be reported in conjunction with CPT code 43210 or 69990, and for diverticulectomy of the hypopharynx or esophagus using an open approach, different codes should be used.

2. Official Description

The official description of CPT code 43180 is: ‘Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed.’ It is important to note that this code should not be reported with certain other codes, as mentioned earlier.

3. Procedure

1. During the procedure, the provider inserts a rigid endoscope through the patient’s mouth and advances it down the throat into the esophagus.
2. Using an operating microscope or telescope, the provider visualizes the hypopharynx or cervical esophagus to identify the diverticulum.
3. An incision is made in the cricopharyngeus muscle, which is located at the lower end of the pharynx and guards the entrance into the esophagus.
4. The provider excises the diverticulum and repairs the incision in the muscle if necessary.
5. Hemostasis is ensured, and the site is flushed with sterile saline.
6. Finally, the endoscope is removed.

4. Qualifying circumstances

CPT 43180 is performed on patients with a specific condition known as Zenker’s diverticulum, which is an esophageal diverticulum typically found at the back of the throat and more common in older individuals. The procedure is performed by a provider using a rigid endoscope and may involve the use of an operating microscope or telescope. The diverticulectomy is accompanied by a cricopharyngeal myotomy, which involves making an incision in the cricopharyngeus muscle. It is important to note that this procedure should not be reported with certain other codes, as mentioned earlier.

5. When to use CPT code 43180

CPT code 43180 should be used when a provider performs a rigid esophagoscopy with diverticulectomy of the hypopharynx or cervical esophagus, along with cricopharyngeal myotomy and repair. It is important to ensure that the procedure meets the specific criteria outlined in the code description and that it is not reported with certain other codes, as mentioned earlier.

6. Documentation requirements

To support a claim for CPT code 43180, the provider must document the following information:

• Patient’s diagnosis of Zenker’s diverticulum
• Details of the procedure performed, including the use of a rigid endoscope, operating microscope or telescope, diverticulectomy, cricopharyngeal myotomy, and repair
• Date of the procedure
• Any additional relevant information or findings during the procedure
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 43180, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should not be reported with certain other codes, as mentioned earlier. It is also important to follow any additional guidelines provided by the payer or coding guidelines. It is recommended to review the specific billing guidelines for this code to ensure accurate reporting.

8. Historical information

CPT code 43180 was added to the Current Procedural Terminology system on January 1, 2015. There have been no updates to the code since its addition.

9. Examples

1. A provider performs a rigid esophagoscopy with diverticulectomy and cricopharyngeal myotomy for a patient with Zenker’s diverticulum.
2. During a procedure, a provider uses a rigid endoscope to perform a diverticulectomy and cricopharyngeal myotomy for a patient with a hypopharyngeal diverticulum.
3. A patient undergoes a rigid esophagoscopy with diverticulectomy and repair for a cervical esophageal diverticulum.
4. A provider performs a diverticulectomy and cricopharyngeal myotomy using a rigid endoscope for a patient with a Zenker’s diverticulum.
5. During a procedure, a provider excises a hypopharyngeal diverticulum and performs a cricopharyngeal myotomy using a rigid endoscope.
6. A patient undergoes a rigid esophagoscopy with diverticulectomy and repair for a cervical esophageal diverticulum.