How To Use CPT Code 43314

CPT 43314 describes a specific procedure for the repair of a congenital esophageal defect using a thoracic approach. 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 43314?

CPT 43314 is a code used to describe a surgical procedure that involves the repair or reconstruction of a congenital esophageal defect. This procedure is performed through a thoracic approach, which means that an incision is made in the chest to access the target area. The repair may also include the closure of a congenital tracheoesophageal fistula, which is an abnormal connection between the trachea and esophagus.

2. Official Description

The official description of CPT code 43314 is: ‘Esophagoplasty for congenital defect (plastic repair or reconstruction), thoracic approach; with repair of congenital tracheoesophageal fistula.’ It is important to note that modifier 63 should not be reported in conjunction with this code.

3. Procedure

1. The procedure begins with the patient being appropriately prepped and anesthetized.
2. The provider makes an incision in the chest to enter the thoracic cavity.
3. Once inside, the provider identifies and inspects the area of the congenital esophageal defect.
4. The defect is repaired, which may involve repairing a perforation of the trachea or esophagus, or an incomplete esophagus by anastomosing the ends together.
5. If a tracheoesophageal fistula is present, the provider severs the connection between the trachea and esophagus and repairs the trachea in layers with sutures.
6. The provider further examines the esophagus and closes any remaining openings or areas of damage using sutures or other means.
7. To reduce the chance of the fistula reforming, a film or pedicle muscle patch may be placed between the trachea and esophagus.
8. The provider ensures hemostasis and closes the chest incision in layers.

4. Qualifying circumstances

CPT 43314 is performed on patients with congenital esophageal defects that require surgical repair. These defects are present at birth and may include tracheoesophageal fistulas. The procedure is typically performed on newborns, including premature infants. Modifier 63 should not be used with this code.

5. When to use CPT code 43314

CPT code 43314 should be used when a provider performs esophagoplasty for a congenital esophageal defect using a thoracic approach and includes the repair of a congenital tracheoesophageal fistula. It is important to note that this code should not be used for noncongenital defects or when the repair does not involve a tracheoesophageal fistula.

6. Documentation requirements

To support a claim for CPT 43314, the provider must document the following information:

• Patient’s diagnosis of a congenital esophageal defect and the need for surgical repair
• Details of the procedure, including the thoracic approach and repair of the tracheoesophageal fistula
• Date of the procedure
• Any additional procedures performed during the same session
• Any complications or unexpected findings
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43314, ensure that the procedure meets the criteria for a congenital esophageal defect repair using a thoracic approach and includes the repair of a tracheoesophageal fistula. Modifier 63 should not be used with this code. It is important to review payer guidelines for any additional requirements or considerations when reporting this code.

8. Historical information

CPT 43314 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates or changes to the code since its addition. However, it is worth noting that this procedure is listed as an inpatient-only (IPO) service by Medicare.

9. Examples

1. A provider performs esophagoplasty for a congenital esophageal defect using a thoracic approach and repairs a tracheoesophageal fistula in a newborn.
2. A premature infant undergoes esophagoplasty for a congenital esophageal defect with repair of a tracheoesophageal fistula using a thoracic approach.
3. A provider performs esophagoplasty for a congenital esophageal defect and repairs a tracheoesophageal fistula in a newborn with additional complications.
4. An infant with a congenital esophageal defect and tracheoesophageal fistula undergoes esophagoplasty using a thoracic approach.
5. A provider performs esophagoplasty for a congenital esophageal defect with repair of a tracheoesophageal fistula in a newborn with gastroesophageal reflux.
6. An infant with a congenital esophageal defect and tracheoesophageal fistula undergoes esophagoplasty using a thoracic approach with repair of esophageal atresia.