How To Use CPT Code 43288

CPT 43288 describes a specific surgical procedure known as esophagectomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43288?

CPT 43288 is a code used to describe a surgical procedure called esophagectomy. This procedure involves the removal of all or most of the esophagus, along with other related surgical steps. It is typically performed 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 43288 is: ‘Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, thoracoscopic, laparoscopic and cervical incision esophagectomy, McKeown esophagectomy, tri-incisional esophagectomy).’

3. Procedure

1. The surgeon begins by making small incisions in the chest (thorax) and inserting trocars, which are tubelike devices with pointed ends.
2. Using a thoracoscope and other surgical instruments, the surgeon mobilizes the upper, middle, and lower mediastinal esophagus by separating connective tissues, tying off blood vessels, and removing adhesions.
3. Next, the surgeon makes small incisions in the abdomen and subcoastal region, inserting trocars, a camera, and instruments.
4. Through these incisions, the surgeon visualizes the stomach and gastroesophageal (GE) junction, divides the esophagus from the stomach, and removes the proximal part of the stomach.
5. If necessary, the surgeon may perform a pyloric drainage procedure to improve the flow of food from the stomach to the intestines.
6. The surgeon then makes an incision in the upper chest/neck area and pulls the stomach up, identifying and dividing the esophagus proximally from the pharynx.
7. Depending on the extent of the procedure, the surgeon connects the proximal end of the stomach to either the remnant of the esophagus or the pharynx.
8. After checking for leaks and bleeding, the surgeon removes the scopes, camera, and instruments and closes all incisions in layers.

4. Qualifying circumstances

CPT 43288 is typically performed on patients with conditions such as esophageal cancer, severe esophageal damage, or spontaneous ruptures of the esophagus. The procedure involves the mobilization of the upper, middle, and lower mediastinal esophagus using thoracoscopic techniques, along with other related surgical steps. It is important to note that CPT 43288 should not be reported in conjunction with code 32551 for right tube thoracostomy.

5. When to use CPT code 43288

CPT code 43288 should be used when a surgeon performs a total or near-total esophagectomy with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, along with other specified procedures. It is important to review the documentation and ensure that all necessary steps of the procedure are performed before reporting this code.

6. Documentation requirements

To support a claim for CPT 43288, the surgeon must document the following information:

• Patient’s diagnosis necessitating the esophagectomy
• Details of the surgical procedure, including the specific steps performed
• Date of the procedure
• Any additional procedures performed, such as laparoscopic pyloric drainage
• Any complications or unexpected findings during the procedure
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 43288, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The surgeon should be familiar with the guidelines and documentation requirements to accurately report this code. It is also important to note that CPT 43288 should not be reported in conjunction with code 32551 for right tube thoracostomy.

8. Historical information

CPT 43288 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.

9. Examples

1. A patient with esophageal cancer undergoes a total esophagectomy with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, along with laparoscopic proximal gastrectomy and open cervical pharyngogastrostomy.
2. A patient with severe esophageal damage undergoes a near-total esophagectomy with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, laparoscopic proximal gastrectomy, and laparoscopic pyloric drainage procedure.
3. A patient with a spontaneous rupture of the esophagus undergoes a total esophagectomy with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, laparoscopic proximal gastrectomy, and esophagogastrostomy.