Otolaryngology Coding Alert

Question: Which CPTcode should I use for an endoscopic staple-assisted Zenker's diverticulectomy (ZD)?

Georgia Subscriber

Answer: CPT doesn't contain a code for noninvasive endoscopic staple diverticulectomy. Therefore, you should report an unlisted-procedure code (43499, Unlisted procedure, esophagus).

Traditionally, otolaryngologists use a transcervical approach (43130, Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach), which requires a lateral neck incision, to remove a ZD (a back-of-the-throat pouch). Physicians now prefer the endoscopic stapling procedure, which requires no incisions and resects the common wall with a gastrointestinal stapler.

As with any claim that includes an unlisted-procedure code, submit the claim electronically and send back-up documentation with a copy. Include documentation and a cover letter explaining the procedure.

-- Answers to You Be the Coder and Reader Questions provided by Andrew Borden, CCS-P, CPC, CMA, otolaryngology and communication sciences department reimbursement manager at Medical College of Wisconsin in Milwaukee; Barbara Cobuzzi, MBA, CPC, CPC-H, an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions, a medical billing firm in Brick, N.J.; and Tara R. Ritter, appeals coordinator for American Physician Services, which serves multiple ENT, allergy, sinus and head and neck practices in Atlanta.