How To Use CPT Code 43312

CPT 43312 describes a specific procedure known as esophagoplasty with repair of tracheoesophageal fistula. 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 43312?

CPT 43312 is a code used to describe a surgical procedure called esophagoplasty with repair of tracheoesophageal fistula. This procedure involves the plastic repair or reconstruction of an esophageal defect through a thoracic approach, along with the repair of the abnormal opening between the trachea and esophagus.

2. Official Description

The official description of CPT code 43312 is: ‘Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula.’

3. Procedure

1. The provider begins by making an incision in the chest to access the damaged area and the tracheoesophageal fistula.
2. They then separate the connection between the trachea and esophagus and repair the trachea using sutures.
3. The provider thoroughly examines the esophagus and closes the remaining opening of the fistula, repairing any other areas of damage as necessary.
4. To reduce the risk of the fistula reforming, a film may be placed between the trachea and esophagus.
5. Hemostasis is ensured, and the chest incision is closed in layers.

4. Qualifying circumstances

CPT 43312 is performed on patients who require plastic repair or reconstruction of the esophagus and have a tracheoesophageal fistula. This procedure is typically done through a thoracic approach, and the patient must meet the specific criteria for this surgery.

5. When to use CPT code 43312

CPT code 43312 should be used when a provider performs esophagoplasty with repair of tracheoesophageal fistula. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 43312, the provider must document the following information:

• Patient’s diagnosis necessitating the esophagoplasty and repair of tracheoesophageal fistula
• Details of the procedure, including the thoracic approach and specific techniques used
• Date of the surgery
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43312, ensure that the procedure performed meets the criteria described in the official description. It is important to follow the specific guidelines provided by the payer and accurately document the procedure to support the claim.

8. Historical information

CPT 43312 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition. However, it is worth noting that Medicare added this procedure to the Inpatient Only (IPO) list in 2017.

9. Examples

1. A patient undergoes esophagoplasty with repair of tracheoesophageal fistula due to a congenital abnormality.
2. A provider performs esophagoplasty with repair of tracheoesophageal fistula in a patient who developed the condition as a result of trauma.
3. An individual with a history of esophageal cancer undergoes esophagoplasty with repair of tracheoesophageal fistula as part of their treatment plan.
4. A patient with a chronic condition requiring esophageal reconstruction undergoes esophagoplasty with repair of tracheoesophageal fistula.
5. A provider performs esophagoplasty with repair of tracheoesophageal fistula in a patient with a history of recurrent respiratory infections.
6. An individual with a congenital tracheoesophageal fistula undergoes esophagoplasty to repair the defect.
7. A patient with a history of esophageal strictures undergoes esophagoplasty with repair of tracheoesophageal fistula to improve their swallowing function.
8. A provider performs esophagoplasty with repair of tracheoesophageal fistula in a patient with a history of gastroesophageal reflux disease (GERD).
9. An individual with a history of radiation therapy for head and neck cancer undergoes esophagoplasty with repair of tracheoesophageal fistula.
10. A patient with a congenital esophageal abnormality undergoes esophagoplasty with repair of tracheoesophageal fistula to improve their quality of life.