How To Use CPT Code 43320

CPT 43320 describes a surgical procedure known as esophagogastrostomy. 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 43320?

CPT 43320 is a code used to describe a surgical repair procedure performed on the lower esophagus and upper stomach. This procedure may involve vagotomy and pyloroplasty, and it can be done through either a transabdominal or transthoracic approach. It is important to note that for laparoscopic procedures, a different code, 43280, should be used.

2. Official Description

The official description of CPT code 43320 is: ‘Esophagogastrostomy (cardioplasty), with or without vagotomy and pyloroplasty, transabdominal or transthoracic approach.’ It is worth mentioning that this code was added to the Current Procedural Terminology system on January 1, 1990.

3. Procedure

1. During the esophagogastrostomy procedure, the healthcare provider begins by making an incision in either the side of the chest or the upper abdomen, depending on the case.
2. Next, the provider identifies the damaged part of the esophagus and may choose to resect it if necessary.
3. If vagotomy is required, the provider performs a surgical division of the vagus nerve to decrease acid production and aid patients with acid reflux.
4. The provider also inspects the stomach and, if there is narrowing of the stomach outlet (pylorus), performs pyloroplasty to enlarge it.
5. Throughout the procedure, the provider ensures hemostasis and closes the incision in layers.

4. Qualifying circumstances

CPT 43320 is typically performed on patients who require a repair of the lower esophagus and upper stomach. This procedure may be necessary for conditions such as gastric cardiac sphincter issues, esophageal damage, or pyloric narrowing. The decision to perform vagotomy and pyloroplasty depends on the specific needs of the patient. It is important to consult with a qualified healthcare provider to determine if CPT 43320 is appropriate for a particular case.

5. When to use CPT code 43320

CPT code 43320 should be used when a provider performs an esophagogastrostomy procedure with or without vagotomy and pyloroplasty. It is important to note that for laparoscopic procedures, a different code, 43280, should be used. It is crucial to review the documentation and consult with a qualified healthcare provider to ensure accurate coding.

6. Documentation requirements

To support a claim for CPT 43320, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for esophagogastrostomy
• Details of the procedure performed, including any additional procedures such as vagotomy and pyloroplasty
• Approach used (transabdominal or transthoracic)
• Date of the procedure
• Any complications or unexpected findings
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43320, it is important to ensure that the procedure was performed using the appropriate approach (transabdominal or transthoracic). Additionally, it is crucial to review the documentation and consult with a qualified healthcare provider to ensure accurate coding. It is also important to note that CPT code 43320 should not be reported with other codes such as 43280 for laparoscopic procedures. Familiarize yourself with the specific billing guidelines provided by the payer to ensure proper reimbursement.

8. Historical information

CPT 43320 was added to the Current Procedural Terminology system on January 1, 1990. It is worth noting that there have been no updates to the code since its addition. However, it is always important to stay updated with any changes or revisions to the coding guidelines.

9. Examples

1. A patient undergoes an esophagogastrostomy procedure with vagotomy and pyloroplasty to repair damage to the lower esophagus and upper stomach.
2. A healthcare provider performs an esophagogastrostomy with pyloroplasty to address pyloric narrowing in a patient.
3. An individual requires an esophagogastrostomy procedure with vagotomy to manage their acid reflux condition.
4. A patient undergoes an esophagogastrostomy with pyloroplasty to treat gastric cardiac sphincter issues.
5. A healthcare provider performs an esophagogastrostomy procedure without vagotomy or pyloroplasty to repair damage to the lower esophagus.
6. A patient requires an esophagogastrostomy with vagotomy and pyloroplasty to address both esophageal damage and pyloric narrowing.
7. An individual undergoes an esophagogastrostomy procedure with pyloroplasty to treat gastric cardiac sphincter issues.
8. A healthcare provider performs an esophagogastrostomy with vagotomy to manage acid reflux in a patient.
9. A patient requires an esophagogastrostomy procedure without vagotomy or pyloroplasty to repair damage to the lower esophagus.
10. An individual undergoes an esophagogastrostomy with vagotomy and pyloroplasty to address both esophageal damage and pyloric narrowing.