CPT® 2018 Quiz: Can You Say Laparoscopic Esophagectomy Three Times Fast?

CPT 2018 esophagectomy

Have you mastered which laparoscopic esophagectomy procedures match to the three new options in the CPT® 2018 code set? The descriptors for 43286-43288 are dense, packed with anatomic and surgical terms that sometimes hit the eight-syllable mark. So if you know which terms to look for in your documentation to help narrow down your code choice, your work will be a lot easier. Let’s do a quick quiz.

Meet the Laparoscopic Esophagectomy Codes

If these new codes are ones you’ll use, then you already know the esophagus is the tube that runs from the throat to the stomach. The suffix -ectomy means removal of a body part. Put it all together, and esophagectomy is removal of all or part of the esophagus, the tube from throat to stomach.

The new codes are specific to procedures that involve laparoscopic (minimally invasive/keyhole) surgery, but there may be an open surgical component included in the code descriptor as well. Specifically, you should watch for open cervical pharyngogastrostomy or esophagogastrostomy in 43286 and 43288. Lesson learned: Don’t let the word “open” in your documentation steer you automatically away from considering these new codes.

The descriptors for 43286-43288 include parentheticals specifying which procedures the codes apply to. But to keep the quiz a challenge, I’ve cut the descriptors below short by removing the parentheticals.

Here are the new codes and (shortened) descriptors:

  • 43286 (Esophagectomy, total or near total, with laparoscopic mobilization of the abdominal and mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy …)
  • 43287 (Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic esophagogastrostomy …)
  • 43288 (Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy …).

Let the Quiz Begin!

Decide whether 43286, 43287, or 43288 applies to each procedure below. Then check your choices in the Answers section.

  1. Laparoscopic transhiatal esophagectomy
  2. McKeown esophagectomy
  3. Ivor Lewis esophagectomy
  4. Tri-incisional esophagectomy

Answers: How Did You Do?

  1. Laparoscopic transhiatal esophagectomy is listed in the descriptor for 43286. Term tip: The esophageal hiatus is an opening in the diaphragm that the esophagus passes through. If documentation shows transhiatal esophagectomy without a laparoscopic approach, check code 43107.
  2. The correct code for laparoscopic McKeown esophagectomy is 43288. Coding tip: Don’t jump automatically to 43288 when you see McKeown in the documentation. The updated 2018 descriptor for 43112 (esophagectomy with thoracotomy) also lists McKeown esophagectomy. You always should review the full descriptor and any guidelines accompanying a code before determining which code is appropriate for your case. Watching for descriptor terms like laparoscopic in 43288 and thoracotomy in 43112 can help point you in the right direction.
  3. For laparoscopic Ivor Lewis, look to 43287. A tip worth repeating: Just as in #2, you’ve got to be sure you don’t let a procedure name get you off track. Ivor Lewis is also in the descriptor for esophagectomy with thoracotomy code 43117. Procedure names may narrow your options, but you’ve got to do more work to be sure you’ve got the correct code.
  4. Tri-incisional esophagectomy also belongs under 43288. Sensing a trend? If your documentation shows a thoracotomy, check 43112 instead. Along with McKeown, that code descriptor also lists tri-incisional esophagectomy.

What About You?

Which terms do your surgeons use for these procedures? Do your coders and providers talk about matching documentation terms and code descriptor terms as part of documentation training?

 

About 

Deborah concentrates on coding and compliance for radiology and cardiology, including the tricky world of interventional procedures, as well as oncology and hematology. Since joining The Coding Institute in 2004, she’s also covered the ins and outs of coding for orthopedics, audiology, skilled nursing facilities (SNFs), and more.

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