How To Use CPT Code 43330

CPT 43330 describes a surgical procedure known as esophagomyotomy, specifically performed through an abdominal approach. This article will provide an overview of CPT code 43330, 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 43330?

CPT 43330 is a code used to describe a surgical procedure called esophagomyotomy. This procedure involves repairing the esophagus by making incisions in the muscles of the lower esophagus and upper stomach. The provider then creates a flap and sutures it back to the esophagus. It is important to note that this specific code refers to the abdominal approach of performing esophagomyotomy.

2. Official Description

The official description of CPT code 43330 is: ‘Esophagomyotomy (Heller type); abdominal approach.’ This code is used when the provider performs an esophagomyotomy procedure through an abdominal incision.

3. Procedure

1. The provider begins by making an incision in the upper abdomen or laterally in the left upper quadrant.
2. Once inside the abdomen, the provider identifies the esophagus and stomach.
3. Using a scalpel, the provider carefully incises the superficial layers of the esophagus, lower esophageal sphincter, and stomach, while leaving the inner layer intact.
4. This incision creates a flap that the provider wraps around the distal esophagus, causing the sphincter to close when the stomach contracts, thus limiting reflux.
5. The provider ensures hemostasis and closes the abdominal incision in layers.

4. Qualifying circumstances

CPT 43330 is typically performed as a surgical treatment for a condition called esophageal achalasia. Esophageal achalasia is characterized by the failure of the esophageal sphincter to relax and the esophageal muscles to propel food, making swallowing and the passage of food into the stomach difficult. This procedure allows the esophageal sphincter to relax properly and enables food to pass into the stomach. It is important to note that this code specifically refers to the abdominal approach of performing esophagomyotomy.

5. When to use CPT code 43330

CPT code 43330 should be used when the provider performs an esophagomyotomy procedure through an abdominal incision. It is important to ensure that the procedure is performed using the abdominal approach and not the thoracic approach, as there is a separate code for the latter (CPT 43331). This code should be used when the provider repairs the esophagus by incising the muscles of the lower esophagus and upper stomach and creating a flap that is sutured back to the esophagus.

6. Documentation requirements

To support a claim for CPT code 43330, the provider must document the following information:

• Patient’s diagnosis of esophageal achalasia
• Details of the abdominal approach used for the procedure
• Date of the procedure
• Incision site and description of the incision
• Specific steps performed during the procedure, including the incision of the esophagus, lower esophageal sphincter, and stomach, as well as the creation and suturing of the flap
• Confirmation of hemostasis
• Description of the closure of the abdominal incision
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 43330, it is important to ensure that the procedure was performed through the abdominal approach. If the thoracic approach was used instead, a different code (CPT 43331) should be reported. Additionally, it is crucial to follow any specific billing guidelines provided by the payer or coding guidelines. It is also important to note that CPT code 43330 should not be reported with other codes unless specified by the payer or coding guidelines.

8. Historical information

CPT code 43330 was added to the Current Procedural Terminology system on January 1, 1990. One notable historical change occurred in 2017 when it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A surgeon performs an esophagomyotomy through an abdominal incision to treat a patient with esophageal achalasia.
2. A patient with difficulty swallowing undergoes an esophagomyotomy procedure through an abdominal approach to alleviate their symptoms.
3. A provider performs an esophagomyotomy on a patient with esophageal achalasia using the abdominal approach, allowing food to pass into the stomach more easily.
4. An individual with esophageal achalasia undergoes an esophagomyotomy through an abdominal incision to improve their ability to swallow.
5. A surgeon repairs the esophagus of a patient with esophageal achalasia by performing an esophagomyotomy through an abdominal approach.
6. An individual with esophageal achalasia undergoes an esophagomyotomy procedure through an abdominal incision to relieve their difficulty in swallowing.
7. A provider performs an esophagomyotomy through an abdominal approach to treat a patient with esophageal achalasia, allowing for improved passage of food into the stomach.