2025 CPT code 43499
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Unlisted procedure, esophagus.
Modifiers may be applicable depending on the specific circumstances of the procedure (e.g., 51 for multiple procedures, 53 for discontinued procedures). Modifier 22 (Increased Procedural Services) may be appropriate if the procedure was significantly more complex than usual for an unlisted esophagus procedure. Consultation with the specific payer is crucial when applying modifiers to code 43499.
Medical necessity must be clearly documented for procedures billed under 43499. This documentation should include the patient's diagnosis, the reason the procedure was performed, and how it addressed the patient's condition.It should also explain why other, more established procedures were not suitable.
The physician is responsible for performing a procedure on the esophagus that is not described by any other CPT code. This requires precise documentation and often involves novel or complex interventions.
In simple words: This code is used when a doctor does a procedure on the esophagus that doesn't have its own specific code.It's for unusual or new procedures.The doctor's notes need to explain exactly what was done.
This code is used for reporting new or unusual procedures performed on the esophagus that do not have a dedicated CPT code. It is essential to provide detailed documentation with the claim when using this code to clarify the exact nature of the procedure performed.
Example 1: A patient presents with a rare congenital anomaly of the esophagus requiring a novel surgical repair. As no specific CPT code exists for this unique procedure, 43499 is reported along with detailed operative notes., A physician performs an experimental endoscopic procedure involving laser ablation of a precancerous lesion in the esophagus. Due to the innovative nature of this procedure, 43499 is used and supported by comprehensive documentation of the technique., A foreign body lodged in the esophagus requires a complex retrieval technique not covered by existing CPT codes.The physician uses an innovative endoscopic approach and reports the procedure with 43499, along with detailed documentation explaining the method used.
Detailed operative report describing the procedure performed, including the approach, instruments used, and the reason why a specific CPT code is not applicable.Supporting documentation may also include pre- and post-operative diagnoses, imaging studies, and any other relevant clinical information.
** Always verify payer-specific guidelines for reporting unlisted codes like 43499, as requirements can vary. Be prepared to provide extensive supporting documentation to ensure proper reimbursement.
- Revenue Code: P1G
- Payment Status: Active
- Specialties:Gastroenterology, Thoracic Surgery, Otolaryngology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center