How To Use CPT Code 43287

CPT 43287 describes a specific surgical procedure involving the removal of two-thirds of the lower esophagus and part of the upper stomach. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43287?

CPT 43287 is a code used to describe a surgical procedure that involves the removal of two-thirds of the lower esophagus and part of the upper stomach. This procedure is performed using laparoscopic and thoracoscopic approaches, allowing for minimally invasive surgery. It may also include a pyloric drainage procedure if necessary. The purpose of this procedure is to treat conditions such as esophageal cancer, severe damage to the esophagus, or spontaneous ruptures of the esophagus.

2. Official Description

The official description of CPT code 43287 is the following: ‘Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic esophagogastrostomy (i.e., laparoscopic thoracoscopic esophagectomy, Ivor Lewis esophagectomy).’ It is important to note that this code should not be reported in conjunction with code 32551 for right tube thoracostomy.

3. Procedure

1. The surgeon begins by making small incisions in the abdomen and subcoastal region, through which trocars are inserted.
2. A laparoscope is inserted through one of the trocars to provide visualization of the surgical area.
3. The surgeon mobilizes the lower part of the esophagus behind the mediastinum and in the abdomen using laparoscopic access.
4. The upper two-thirds of the esophagus are mobilized through a thoracoscopic approach.
5. The surgeon removes two-thirds of the lower esophagus and the proximal part of the stomach.
6. If necessary, a pyloric drainage procedure may be performed during the laparoscopic portion of the procedure.
7. The surgeon connects the proximal end of the stomach to the remnant of the esophagus through a thoracoscopic approach.
8. The anastomosis, or surgical connection, between the stomach and esophagus is checked for leaks and bleeding.
9. The incisions are closed, completing the procedure.

4. Qualifying circumstances

CPT 43287 is typically performed for patients with esophageal cancer, severe damage to the esophagus, or spontaneous ruptures of the esophagus. The procedure requires the use of laparoscopic and thoracoscopic approaches, making it a minimally invasive surgery. It is important to note that this code should not be reported in conjunction with code 32551 for right tube thoracostomy.

5. When to use CPT code 43287

CPT code 43287 should be used when a surgeon performs an esophagectomy, specifically removing two-thirds of the lower esophagus and part of the upper stomach. This procedure is typically performed using laparoscopic and thoracoscopic approaches. It is important to ensure that the documentation supports the use of this code and that it is not reported in conjunction with code 32551 for right tube thoracostomy.

6. Documentation requirements

To support a claim for CPT code 43287, the documentation should include:

• Patient’s diagnosis necessitating the esophagectomy
• Details of the laparoscopic and thoracoscopic approaches used
• Description of the specific portions of the esophagus and stomach removed
• Documentation of any additional procedures performed, such as pyloric drainage
• Confirmation of the anastomosis between the stomach and esophagus
• Verification of any leaks or bleeding during the procedure
• Closure of the incisions

7. Billing guidelines

When billing for CPT code 43287, it is important to ensure that the documentation supports the use of this specific procedure. It should not be reported in conjunction with code 32551 for right tube thoracostomy. It is also essential to follow any additional guidelines provided by payers or coding authorities. It is recommended to review the complete documentation and guidelines to accurately report this code.

8. Historical information

CPT code 43287 was added to the Current Procedural Terminology system on January 1, 2018. It was also added to the Inpatient Only (IPO) list for Medicare in 2018. There have been no updates or changes to this code since its addition.

9. Examples

1. A patient with esophageal cancer undergoes CPT code 43287, which involves the removal of two-thirds of the lower esophagus and part of the upper stomach using laparoscopic and thoracoscopic approaches.
2. A patient with severe damage to the esophagus undergoes CPT code 43287, which includes the removal of two-thirds of the lower esophagus and part of the upper stomach, along with a pyloric drainage procedure if necessary.
3. A patient with a spontaneous rupture of the esophagus undergoes CPT code 43287, which involves the removal of two-thirds of the lower esophagus and part of the upper stomach, followed by the connection of the stomach to the remnant of the esophagus through a thoracoscopic approach.