How To Use CPT Code 43425

CPT 43425 describes the closure of a previously placed esophagostomy or fistula through either a transthoracic or midline abdominal incision. 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 43425?

CPT 43425 can be used to describe the closure of a previously placed esophagostomy or fistula through either a transthoracic or midline abdominal incision. This code is used when the wound or injury for which the esophagostomy was placed has healed, and the patient no longer needs to be fed through a tube.

2. Official Description

The official description of CPT code 43425 is the closure of esophagostomy or fistula through a transthoracic or transabdominal approach. It is important to note that this code should not be used for transabdominal paraesophageal hiatal hernia repair or transthoracic diaphragmatic hernia repair, as separate codes exist for these procedures.

3. Procedure

1. The provider begins by making an incision between the 6th and 7th ribs or in the upper midline of the abdomen, depending on the approach chosen.
2. After appropriate prepping and anesthesia, the provider dissects down to the opening of the esophagostomy or fistula.
3. Scar tissue is carefully cut away, and the esophagus is detached from the subcutaneous tissues and skin.
4. The provider then repairs the esophagus using layered sutures to ensure proper closure.
5. Hemostasis is ensured, and the provider closes the skin incision in layers.

4. Qualifying circumstances

CPT 43425 is performed on patients who have previously had an esophagostomy or fistula placed and no longer require tube feeding. The closure is done through either a transthoracic or midline abdominal incision. It is important to note that this code should not be used for other procedures such as transabdominal paraesophageal hiatal hernia repair or transthoracic diaphragmatic hernia repair, as separate codes exist for these specific procedures.

5. When to use CPT code 43425

CPT code 43425 should be used when a provider is closing a previously placed esophagostomy or fistula through either a transthoracic or midline abdominal incision. It is important to ensure that the wound or injury for which the esophagostomy was placed has healed and the patient no longer requires tube feeding.

6. Documentation requirements

To support a claim for CPT 43425, the provider must document the following information:

• Reason for the closure of the esophagostomy or fistula
• Approach used (transthoracic or midline abdominal)
• Date of the procedure
• Details of the procedure, including any complications or additional steps taken
• Confirmation that the wound or injury has healed and the patient no longer requires tube feeding
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43425, it is important to ensure that the closure of the esophagostomy or fistula is performed through either a transthoracic or midline abdominal approach. This code should not be reported for other procedures such as transabdominal paraesophageal hiatal hernia repair or transthoracic diaphragmatic hernia repair, as separate codes exist for these specific procedures. It is also important to follow any additional guidelines provided by payers or coding authorities.

8. Historical information

CPT 43425 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone no updates since its addition. However, it is important to stay updated with any changes or revisions to coding guidelines and documentation requirements.

9. Examples

1. A patient who had an esophagostomy placed for feeding purposes undergoes closure of the esophagostomy through a transthoracic approach.
2. A patient with a fistula that has healed no longer requires tube feeding, and the provider performs closure of the fistula through a midline abdominal incision.
3. After the wound from an esophagostomy has healed, the provider closes the opening through a transthoracic approach.
4. A patient who previously required tube feeding due to an esophagostomy no longer needs the feeding tube, and the provider performs closure of the esophagostomy through a midline abdominal incision.
5. Following the healing of a fistula, the provider closes the opening through a transthoracic approach.
6. A patient who had an esophagostomy placed for feeding purposes undergoes closure of the esophagostomy through a midline abdominal incision.
7. After the wound from a fistula has healed, the provider closes the opening through a transthoracic approach.
8. A patient who previously required tube feeding due to an esophagostomy no longer needs the feeding tube, and the provider performs closure of the esophagostomy through a midline abdominal incision.
9. Following the healing of a fistula, the provider closes the opening through a transthoracic approach.
10. A patient who had an esophagostomy placed for feeding purposes undergoes closure of the esophagostomy through a midline abdominal incision.