Fundoplasty Gains New Esophagogastric Codes for 2016

Fundoplasty Gains New Esophagogastric Codes for 2016

Esophagogastric fundoplasty involves wrapping the upper portion of the stomach (the fundus) around the esophagus to strengthen the valve between the esophagus and stomach, thereby inhibiting acid from backing up into the esophagus. CPT® 2016 introduces 43210 Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed for partial or complete esophagogastric fundoplasty when performed via flexible, transoral endoscope.

Avoid Reporting with Excluded Services

Per CPT®, do not report 43210 with:

43180 Esophagoscopy, rigid, transoral with diverticulectomy of hypopharynx or cervical esophagus (eg, Zenker’s diverticulum), with cricopharyngeal myotomy, includes use of telescope or operating microscope and repair, when performed

43191 Esophagoscopy, rigid, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed (separate procedure)

43197 Esophagoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)

The most common condition treated with a transoral esophagogastric fundoplasty is gastroesophageal reflux (GERD). In ICD-10-CM there are a few options when reporting GERD. If the patient has GERD without esophagitis (inflammation of the esophagus) you report K21.9 Gastro-esophageal reflux disease without esophagitis. If the patient has GERD and esophagitis, report K21.0 Gastro-esophageal reflux disease with esophagitis. With the creation of the combination code. There is no longer a need to report esophagitis as an additional code.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 402 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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