How To Use CPT Code 43286

CPT 43286 describes a specific surgical procedure involving the removal of all or most of the esophagus, along with the upper part of the stomach. This article will provide an overview of CPT code 43286, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes.

1. What is CPT Code 43286?

CPT 43286 is a code used to describe a surgical procedure known as esophagectomy. This procedure involves the removal of the esophagus, either in its entirety or a significant portion, along with the upper part of the stomach. It is typically performed laparoscopically, with the use of small incisions and specialized instruments to access and remove the affected areas.

2. Official Description

The official description of CPT code 43286 is: ‘Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, laparoscopic transhiatal esophagectomy).’ This description outlines the specific steps and components of the procedure, including the laparoscopic mobilization of the esophagus, proximal gastrectomy, and the open cervical approach for connecting the stomach to the pharynx or remnant of the esophagus.

3. Procedure

1. The surgeon begins by making small incisions in the abdomen and subcoastal region, through which trocars are inserted to provide access for the laparoscope and surgical instruments.
2. Once inside the abdomen, the surgeon identifies the esophagus and divides it proximally from the pharynx and distally from the stomach.
3. If possible, the surgeon saves a portion of the esophagus and makes the division in the neck. If not, the division is made higher up where the esophagus begins at the pharynx.
4. The surgeon then enters the abdominal incision with a camera and instruments to visualize the stomach and gastroesophageal junction.
5. The esophagus is divided from the stomach, and the affected portions are removed.
6. If necessary, the surgeon may perform a pyloric drainage procedure to improve the flow of food from the stomach to the intestines.
7. An incision is made in the upper chest/neck area, and the stomach is pulled up to connect it to the pharynx or remnant of the esophagus.
8. The surgeon checks the anastomosis for leaks and bleeding before closing the incisions.

4. Qualifying circumstances

CPT code 43286 is typically used for patients who require the removal of all or most of the esophagus due to 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 additional components, such as a laparoscopic pyloric drainage procedure. It is important to note that specific patient factors and medical necessity should be considered when determining the appropriateness of using CPT code 43286.

5. When to use CPT code 43286

CPT code 43286 should be used when a surgeon performs a total or near-total esophagectomy, with laparoscopic mobilization of the abdominal and mediastinal esophagus, proximal gastrectomy, and open cervical pharyngogastrostomy or esophagogastrostomy. This code is appropriate for cases where the procedure is performed laparoscopically and involves the removal of a significant portion of the esophagus and upper part of the stomach. It is important to review the specific documentation and medical necessity to ensure accurate coding and billing.

6. Documentation requirements

Documentation for CPT code 43286 should include the following information:

• Patient’s diagnosis necessitating the esophagectomy
• Details of the procedure, including laparoscopic mobilization of the abdominal and mediastinal esophagus, proximal gastrectomy, and open cervical pharyngogastrostomy or esophagogastrostomy
• Date of the procedure
• Start and end times of the procedure
• Any additional procedures performed, such as a laparoscopic pyloric drainage procedure
• Any complications or unexpected findings
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT code 43286, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed laparoscopically, with the removal of all or most of the esophagus and upper part of the stomach. It is also important to review any additional procedures performed during the same operative session and follow any specific billing guidelines provided by payers or coding authorities. Modifier usage should be in accordance with payer requirements.

8. Historical information

CPT code 43286 was added to the Current Procedural Terminology system on January 1, 2018. It was initially listed as an inpatient-only (IPO) procedure, indicating that it was typically performed in a hospital setting for patients requiring hospitalization. It is important to review any updates or changes to the code since its addition to ensure accurate coding and billing.

9. Examples

1. A patient with esophageal cancer undergoes a laparoscopic transhiatal esophagectomy (CPT 43286) to remove the affected portions of the esophagus and upper part of the stomach.