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AMERICANMEDICALASSOCIATION
SPRING2017
15
CPT®Procedural Coding
43279
43279 Laparoscopy, surgical,
esophagomyotomy (Heller type),
with fundoplasty,whenperformed
(For open approach, see 43330,
43331)
(Do not report 43279 in conjunction with
43280)
AMACodingGuideline
LaparoscopicProcedures on the
Esophagus
Surgical laparoscopy always includes diagnostic
laparoscopy.To report a diagnostic laparoscopy
(peritoneoscopy) (separate procedure), use 49320.
PlainEnglishDescription
A laparoscopic Heller-type esophagomyotomy is
performed including a fundoplastywhen needed.
Pneumoperitoneum is established and four to five
laparoscopic ports are inserted across the upper
abdomen.The laparoscope is inserted and the
stomach and esophagus are inspected.The gastric
fundus is grasped and pulled down and short
gastric vessels are divided.The phrenoesophageal
ligament is cut to allow exposure of the anterior
gastric cardia and distal esophagus.The area
behind the esophagogastric junction is dissected
and a drain is placed.The vagus nerves are
identified and protected.An endoscope is used
to identify the squamocolumnar junction.Traction
is applied at the esophagogastric junction
and the gastric cardia is incised longitudinally
beginning just distal to the squamocolumnar
junction and extending into the esophageal
muscle approximately 6-8 cm. Longitudinal and
circularmuscle fibers are divided (myotomy)
and the submucosa is exposed.The stomach is
insufflated through the endoscope and the incision
is inspected to ensure that all muscle fibers
along the entire length of the incision have been
divided.Any undividedmuscle fibers are cut.A
manometry catheter is placed in the stomach and
pressure recordings are obtained.Areas of positive
pressure along the incision site are inspected
again, and intact muscle fibers are identified and
divided. Following completion of themyotomy, a
fundoplasty is performed as needed.To perform a
Dor anterior fundoplasty, the fundus is folded over
the abdominal side of themyotomy and sutured to
the crural diaphragm.
Laparascope
Laparascopic esophagomyotomy
(Heller type) with fundoplasty
Port sites for
Hellermyotomy
Fundusof the stomach
iswrapped around the
distal esophagus
and sutured
Damaged/narrowed
area is repaired
ICD-10-CMDiagnosticCodes
K22.0
Achalasia of cardia
K22.2
Esophageal obstruction
K22.4
Dyskinesia of esophagus
Q39.0
Atresia of esophaguswithout
fistula
Q39.3
Congenital stenosis and stricture of
esophagus
Q39.8
Other congenital malformations of
esophagus
Q39.9
Congenital malformation of
esophagus,unspecified
Q40.8
Other specified congenital
malformations of upper alimentary
tract
Q45.8
Other specified congenital
malformations of digestive system
R13.14
Dysphagia,pharyngoesophageal
phase
R13.19
Other dysphagia
S27.813S Laceration of esophagus (thoracic
part), sequela
S27.818S Other injury of esophagus (thoracic
part), sequela
T79.8XXS Other early complications of
trauma, sequela
7
T88.8
Other specified complications of
surgical andmedical care,not
elsewhere classified
ICD-10-CMCodingNotes
For codes requiring a 7th character extension, refer
to your ICD-10-CM book. Review the character
descriptions and coding guidelines for proper
selection. For some procedures, only certain
characterswill apply.
CCI Edits
Refer toAppendixA for CCI edits.
AMACPTAssistant
43279:
Feb 12: 3
FacilityRVUs
Global: 090
Code Work
PE
Facility
MP
Total
Facility
43279 22.10 10.17 5.16
37.43
Non-facilityRVUs
Code Work PENon-
Facility
MP Total Non-
Facility
43279 22.10 10.17 5.16
37.43
Modifiers
(PAR)
Code Mod
50
Mod
51
Mod
62
Mod
66
Mod
80
43279 0
2
1
0
2
CPT
®
CodingEssentials for General Surgery&Gastroenterology 2017
43279
l
New
s
Revised
:
AddOn
Modifier 51 Exempt
ê
Telemedicine
~
FDA Pending
⇄
Laterality
7
Seventh Character
|
Male
~
Female
CPT© 2016AmericanMedicalAssociation.All Rights Reserved.
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CPT®CODINGESSENTIALS—SIMPLEONE-PAGEVIEWFORMAT
EXCLUSIVE!
Official, code-specificparenthetical
instructions from theAMA's
CPT®Professional codebook
.
PREMIUM!
Pertinentofficial
AMACodingGuidelines
from theCPTEditorialPanel
provide insightsnot
available inother specialtycodebooks.
Crosswalks fromCPT to
ICD-10-CM,
mappedby
codingexperts, guide
accuratecoding selection.
Procedural illustrations
bringclarity and
understanding tocomplex
procedures.
PlainEnglishdescriptions
providea sampleofwhat is
included in the service representedbyeachCPTcode.
CCIedits
determine if code
pairingsareappropriate.
Citations
toadditional
coding resources formore
quality informationand
guidance.
RVUs,global surgerydays,
assist-a-surgeryeditsand
priorauthorization
information
at aglance
increasesefficiency.
Modifiers
clarifywhether
CMSallows theusesof
multipleprocedures,
co-surgeon reduction,
team surgeonor assistant
surgeonmodifiers for a
specificprocedure.
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