How To Use CPT Code 43285

CPT 43285 describes the removal of an esophageal sphincter augmentation device, which is used to prevent the backflow of stomach contents, known as gastroesophageal reflux (GER). This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43285?

CPT 43285 is used to describe the removal of an esophageal sphincter augmentation device. This device is a magnetic band placed around the junction of the esophagus and stomach to narrow the opening and prevent gastroesophageal reflux (GER). The procedure involves the provider making small incisions and using a camera and instruments to remove the device. The incisions are then sutured.

2. Official Description

The official description of CPT code 43285 is: ‘Removal of esophageal sphincter augmentation device.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. A small incision is made at the umbilicus (navel) to insufflate the abdomen with gas, improving visualization.
3. Additional small incisions are made, and a camera and instruments are inserted to perform the procedure.
4. The provider removes the esophageal sphincter augmentation device present at the gastroesophageal junction.
5. All instruments are removed, and the incisions are sutured.

4. Qualifying circumstances

CPT 43285 is performed on patients who have an esophageal sphincter augmentation device that needs to be removed. This device is used to prevent gastroesophageal reflux (GER). The procedure is typically performed when the patient has failed to respond to medical therapy and is not a candidate for other procedures.

5. When to use CPT code 43285

CPT code 43285 should be used when the provider is removing an esophageal sphincter augmentation device. It is important to note that some payers may consider the placement of this device investigational and may not cover the removal procedure. It is recommended to check with Medicare or other payers to determine their coverage policies.

6. Documentation requirements

To support a claim for CPT 43285, the provider must document the following information:

• Patient’s diagnosis and the need for device removal
• Details of the procedure, including the incisions made and the use of camera and instruments
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 43285, ensure that the procedure involves the removal of an esophageal sphincter augmentation device. It is important to note that some payers may consider the placement of this device investigational and may not cover the removal procedure. If the provider also performed the placement of the device, use CPT code 43284 instead. It is recommended to check with Medicare or other payers for their specific coverage policies.

8. Historical information

CPT 43285 was added to the Current Procedural Terminology system on January 1, 2017. There have been no updates to the code since its addition.

9. Examples

1. A patient with an esophageal sphincter augmentation device undergoes a procedure to have the device removed.
2. A provider performs the removal of an esophageal sphincter augmentation device on a patient who has failed to respond to medical therapy for gastroesophageal reflux (GER).
3. A patient who is not a candidate for other procedures has their esophageal sphincter augmentation device removed by a provider.
4. A provider removes an esophageal sphincter augmentation device from a patient who experienced complications related to the device.
5. A patient with an esophageal sphincter augmentation device undergoes a procedure to remove the device due to a change in their medical condition.