How To Use CPT Code 43360

CPT 43360 describes the procedure for gastrointestinal reconstruction in patients who have previously undergone esophagectomy, have obstructing esophageal lesions or fistulas, or have had their esophagus excluded. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43360?

CPT 43360 can be used to describe the procedure of gastrointestinal reconstruction in patients who have undergone esophagectomy, have obstructing esophageal lesions or fistulas, or have had their esophagus excluded. This code is used when the provider repairs the esophagus and other structures of the gastrointestinal system, including the stomach and pylorus if necessary.

2. Official Description

The official description of CPT code 43360 is: ‘Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with stomach, with or without pyloroplasty.’

3. Procedure

1. The provider begins by making one or two incisions in the chest, abdomen, or both, depending on the patient’s specific condition.
2. They then examine the esophageal remnant to identify any obstructions or disease.
3. The problem area is removed, and the esophagus is repaired through dilation or other necessary techniques.
4. If needed, the provider moves the stomach into the chest and attaches it to the esophageal stump.
5. In some cases, the distal stomach, specifically the pylorus, may be widened to facilitate easier passage of food.
6. Hemostasis is ensured, and the provider closes the incisions in the abdomen and chest.

4. Qualifying circumstances

Patients eligible for CPT 43360 are those who have previously undergone esophagectomy, have obstructing esophageal lesions or fistulas, or have had their esophagus excluded. The procedure involves repairing the esophagus and may include reconstruction of the stomach and pylorus. It is important to note that this code should not be used for intestinal interposition or reconstruction, which is covered by a different CPT code.

5. When to use CPT code 43360

CPT code 43360 should be used when the provider performs gastrointestinal reconstruction in patients who meet the qualifying circumstances mentioned above. It is important to accurately document the procedure and ensure that it aligns with the official description of the code.

6. Documentation requirements

To support a claim for CPT 43360, the provider must document the following information:

• Patient’s medical history and indication for gastrointestinal reconstruction
• Details of the procedure performed, including any additional repairs or reconstructions
• Date of the procedure and duration
• Any complications or unexpected findings
• Post-operative care instructions and follow-up plans
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43360, ensure that the procedure aligns with the official description and the patient meets the qualifying circumstances. It is important to accurately document the procedure and provide any necessary supporting documentation. Additionally, be aware of any specific billing guidelines or modifiers that may apply to this code.

8. Historical information

CPT 43360 was added to the Current Procedural Terminology system on January 1, 1995. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient who previously underwent esophagectomy requires gastrointestinal reconstruction to repair an obstructing esophageal lesion.
2. A patient with a fistula in the esophagus needs gastrointestinal reconstruction to address the abnormal passageway.
3. A patient who had their esophagus excluded requires reconstruction to restore normal gastrointestinal function.
4. A provider performs gastrointestinal reconstruction with stomach repair and pyloroplasty in a patient who has previously undergone esophagectomy.
5. A patient with obstructing esophageal lesions undergoes gastrointestinal reconstruction with stomach repair and dilation of the esophagus.
6. Gastrointestinal reconstruction is performed in a patient who had their esophagus excluded, involving repair of the stomach and widening of the pylorus.
7. A provider performs gastrointestinal reconstruction with stomach repair and pyloroplasty in a patient with a history of esophagectomy.
8. Gastrointestinal reconstruction is performed in a patient with obstructing esophageal lesions, involving repair of the esophagus and dilation of the stomach.
9. A patient who previously had their esophagus excluded requires gastrointestinal reconstruction with stomach repair and pyloroplasty.
10. Gastrointestinal reconstruction is performed in a patient with a fistula in the esophagus, involving repair of the esophagus and reconstruction of the stomach.