Wiki repair of hypopharyngeal perforation w/mobilization of a sternothyroid muscle flap cl

[AnneCline]

Help with CPT please! 42953 ? & ?

pt had subplatysmal flaps elevated. strap muscles lateralized, trachea identified. entered plane around the larynx and inherent muscles, and the area was carried down to fat between esophagus and trachea superiorly. mobilized trachea. blunt dissection used and superior portion on left side of larynx was freed and larynx rotated. An opening was found into the hypopharynx. free edges of mucosa grasped and closed with chromic sutures. pt then had sternohyoid muscle dissected free and mobilized over this area. once mobilized, this was oversewn over this area as an additional areea of security. tisseel placed over this area and placement of a JP drain was done.

 

[rachell1976]

My coding companion's explaination of 42953 is:

"the physician repairs a tear at the pharyngeal esophageal junction. After airway is secured, the physician makes a horizontal neck incision and retracts superficial tissues to expose the pharyngeal esophageal junction. The defect is identified, irrigated to reduce infection, and closed in sutured layers"

the Coding tips state:
"For closure with myocutaneous or other flap, use the appropriate code in addition to 42953"

(2009 Ingenix ENT/ Allergy/ Pulmonology: pg 455)

I would be interested to see what anyone else thinks. I can't find another code that is appropriate based on the documentation you list... Maybe more extensive repair?