CPT for ENT: Zenker's Diverticulum

CPT for ENT: Zenker's Diverticulum

Zenker's Diverticulum is a pouch found above the cervical esophagus. It causes swallowing difficulties (Dysphagia), regurgitation, weight loss, and other symptoms. When an Otolaryngologist performs open surgical excision of a Zenker's diverticulum, he or she should report CPT code:

• 43130 - Diverticulectomy of the hypopharynx or esophagus, with or without myotomy; cervical approach

Many of these diverticula may be surgically treated endoscopically. Coding guidance recommends use of an unlisted code to report the endoscopic procedure through the end of 2014; however, a new CPT code has been developed for CY 2015 reporting. Therefore, beginning 1 January 2015, the Academy recommends the following CPT code to properly report endoscopic treatment of a Zenker's diverticulum:

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
(Do not report 43180 in conjunction with 69990)
(For diverticulectomy of hypopharynx or esophagus [open], see 43130, 43135)

Reviewed/revised October 2014
Reviewed April 2008
Reviewed July 2006

Important Disclaimer Notice (Updated 8/7/14)

CPT for ENT articles are a collaborative effort between the Academy’s team of CPT Advisors, members of the Physician Payment Policy (3P) workgroup, and health policy staff. Articles are developed to address common coding questions received by the health policy team, as well as to clarify coding changes and correct coding principles for frequently reported ENT procedures. These articles are not intended as legal, medical, or business advice and are not a guarantee of reimbursement. The information is also not meant to serve as the definitive or sole authority on billing and coding issues. The applicability of AAO-HNS billing and coding guidance for a particular procedure, must be determined by the responsible physician in light of all the circumstances presented by the individual patient. You should consult with your own advisors as well as Medicare or private carriers in making any decisions about how to bill and code particular services or procedures.