How To Use CPT Code 43405

CPT 43405 describes the ligation or stapling at the gastroesophageal junction to treat a pre-existing esophageal perforation. 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 43405?

CPT 43405 is used to describe a surgical procedure in which the provider closes off the esophagus at its junction with the stomach using staples or sutures. This procedure is performed to allow a tear or hole in the esophagus to heal. During the procedure, the provider may also place a feeding tube in the stomach or jejunum to provide nutrition while the patient is unable to eat normally.

2. Official Description

The official description of CPT code 43405 is: ‘Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation.’

3. Procedure

1. The patient is positioned supine on the operating table and prepared for surgery.
2. The provider makes an abdominal incision and identifies the stomach and esophagus.
3. Soft tissues are dissected, and the gastroesophageal junction is identified.
4. The provider closes off the distal esophagus using either a stapler or sutures.
5. In some cases, the provider may bring the esophagus out through the incision to allow for drainage during the healing process.
6. A feeding tube is typically placed in the stomach or jejunum to provide nutrition while the patient is unable to eat normally.
7. The provider ensures hemostasis and closes the abdominal incision in layers.

4. Qualifying circumstances

CPT 43405 is performed on patients with a pre-existing esophageal perforation. This procedure is used to close off the esophagus at its junction with the stomach to allow the perforation to heal. The provider may also place a feeding tube in the stomach or jejunum for nutritional support during the healing process.

5. When to use CPT code 43405

CPT code 43405 should be used when the provider performs ligation or stapling at the gastroesophageal junction for a pre-existing esophageal perforation. This code should not be used for other procedures or conditions.

6. Documentation requirements

To support a claim for CPT 43405, the provider must document the following information:

• Patient’s diagnosis of a pre-existing esophageal perforation
• Description of the procedure performed, including whether ligation or stapling was used
• Date of the procedure
• Details of any additional procedures performed, such as the placement of a feeding tube
• Any complications or unexpected findings during the procedure
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43405, ensure that the procedure meets the criteria for a pre-existing esophageal perforation and that ligation or stapling was performed at the gastroesophageal junction. There are no specific guidelines regarding reporting CPT 43405 with other codes. However, it is important to accurately document and code any additional procedures performed during the same operative session.

8. Historical information

CPT 43405 was added to the Current Procedural Terminology system on January 1, 1995. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare reimbursement purposes.

9. Examples

1. A patient with a pre-existing esophageal perforation undergoes ligation at the gastroesophageal junction to promote healing.
2. A provider performs stapling at the gastroesophageal junction to close off a pre-existing esophageal perforation in a patient.
3. During a surgical procedure, a surgeon uses sutures to ligate the distal esophagus at the gastroesophageal junction to treat a pre-existing esophageal perforation.
4. A patient with a pre-existing esophageal perforation undergoes ligation at the gastroesophageal junction, and a feeding tube is placed in the stomach for nutritional support.
5. A provider performs stapling at the gastroesophageal junction to close off a pre-existing esophageal perforation, and a feeding tube is placed in the jejunum for nutritional support.
6. During a surgical procedure, a surgeon uses sutures to ligate the distal esophagus at the gastroesophageal junction to treat a pre-existing esophageal perforation, and a feeding tube is placed in the stomach for nutritional support.
7. A patient with a pre-existing esophageal perforation undergoes ligation at the gastroesophageal junction to promote healing, and a feeding tube is placed in the jejunum for nutritional support.
8. A provider performs stapling at the gastroesophageal junction to close off a pre-existing esophageal perforation in a patient, and a feeding tube is placed in the stomach for nutritional support.
9. During a surgical procedure, a surgeon uses sutures to ligate the distal esophagus at the gastroesophageal junction to treat a pre-existing esophageal perforation, and a feeding tube is placed in the jejunum for nutritional support.
10. A patient with a pre-existing esophageal perforation undergoes ligation at the gastroesophageal junction to promote healing, and a feeding tube is placed in the stomach for nutritional support.