Otolaryngology Coding Alert

Question: How should we bill for an "endoscopic" removal of Zenker's diverticula?

Colorado Subscriber

Answer: CPT contains a code for an open approach to remove a Zenker's diverticulum (ZD), a pouch that forms at the back of the throat at the junction of the pharynx and the esophagus (the food passage to the stomach). The AMA, however, has not yet created a code for noninvasive endoscopic staple diverticulectomy to remove a ZD, which creates problems such as long-standing swallowing difficulties (dysphagia), regurgitation, bad breath, weight loss and even aspiration (the passage of food or other hazardous material into the lungs), according to the San Diego Center for Voice and Swallowing Web site.

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 the pouch. Physicians now prefer to use the endoscopic stapling procedure, which requires no incisions and uses a gastrointestinal stapler to resect the common wall. Because no code exists for this procedure, you should report an unlisted-procedure code (43499, Unlisted procedure, esophagus). As with any claim containing an unlisted-procedure code, submit the claim manually with a cover letter explaining the procedure and the operative report.