How To Use CPT Code 43313

CPT 43313 describes a specific procedure for the repair of a congenital esophageal defect through a thoracic approach, without the repair of a tracheoesophageal fistula. This article will provide an overview of CPT code 43313, 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 43313?

CPT 43313 is a code used to describe a surgical procedure that involves the plastic repair or reconstruction of a congenital esophageal defect. This procedure is performed through a thoracic approach, which means that the surgeon makes an incision in the chest to access the target area. It is important to note that CPT 43313 does not include the repair of a tracheoesophageal fistula, which is a separate procedure.

2. Official Description

The official description of CPT code 43313 is: ‘Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; without repair of congenital tracheoesophageal fistula.’

3. Procedure

1. The surgeon begins by making an incision in the chest to access the esophagus.
2. They then identify and inspect the area of the congenital defect.
3. The surgeon proceeds to perform the necessary repair or reconstruction of the esophageal defect, excluding any repair of a tracheoesophageal fistula.
4. If there are any perforations in the trachea or esophagus, the surgeon may also repair them during the procedure.
5. In cases where there is an incomplete esophagus, the surgeon opens the dead ends of the esophageal segments and anastomoses them together.
6. The surgeon closes the esophagus in two layers and the trachea in one layer to ensure proper healing.
7. Finally, they close the chest incision in layers to complete the procedure.

4. Qualifying circumstances

CPT 43313 is typically performed on patients with congenital esophageal defects. These defects are present at birth and require surgical intervention for repair or reconstruction. The procedure is performed through a thoracic approach, which involves making an incision in the chest. It is important to note that CPT 43313 does not include the repair of a tracheoesophageal fistula, which is a separate procedure.

5. When to use CPT code 43313

CPT code 43313 should be used when a surgeon performs an esophagoplasty for a congenital esophageal defect through a thoracic approach, without repairing a 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 43313, the following documentation is required:

• Clear indication of the patient’s congenital esophageal defect
• Description of the specific repair or reconstruction performed
• Date of the procedure
• Details of the thoracic approach used
• Any additional repairs or procedures performed during the same surgical session
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 43313, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed through a thoracic approach and should not include the repair of a tracheoesophageal fistula. It is also important to follow any additional guidelines provided by payers or regulatory bodies regarding the use of this code.

8. Historical information

CPT code 43313 was added to the Current Procedural Terminology system on January 1, 2002. Since its addition, there have been no updates or changes to the code.

9. Examples

1. A newborn with a congenital esophageal defect undergoes an esophagoplasty through a thoracic approach, without the repair of a tracheoesophageal fistula.
2. A surgeon performs an esophagoplasty on an infant with a congenital esophageal defect, excluding the repair of a tracheoesophageal fistula.
3. A child with a congenital esophageal defect undergoes a thoracic esophagoplasty, without the repair of a tracheoesophageal fistula.
4. An adolescent with a congenital esophageal defect undergoes a plastic repair through a thoracic approach, without the repair of a tracheoesophageal fistula.
5. A surgeon performs an esophagoplasty on an adult patient with a congenital esophageal defect, excluding the repair of a tracheoesophageal fistula.
6. A thoracic esophagoplasty is performed on a patient with a congenital esophageal defect, without the repair of a tracheoesophageal fistula.
7. A surgeon performs a plastic reconstruction of the esophagus through a thoracic approach on a patient with a congenital defect, excluding the repair of a tracheoesophageal fistula.
8. An esophagoplasty is performed on a newborn with a congenital esophageal defect, without the repair of a tracheoesophageal fistula.
9. A child with a congenital esophageal defect undergoes a thoracic esophagoplasty, excluding the repair of a tracheoesophageal fistula.