Summary & Overview
CPT 43502: Repair of Lower Esophageal Laceration to Control Bleeding
CPT code 43502 denotes surgical suture repair of a preexisting laceration involving the lower esophagus at its entry into the stomach, typically performed to control bleeding from tears at the gastroesophageal junction such as Mallory–Weiss tears. Nationally, this code captures a focused surgical intervention that can be emergent and resource-intensive, with implications for hospital operating room utilization, perioperative care patterns, and payer coverage determinations for acute gastrointestinal bleeding.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise review of clinical context for this procedure, typical sites of service, and the service type. The publication summarizes common billing and coding considerations, outlines payer coverage patterns where available, and identifies areas for attention in claims documentation and surgical reporting. It also situates the procedure within clinical scenarios that prompt urgent intervention, helping coding and clinical teams align documentation to support appropriate billing. Data not available in the input will be noted where applicable.
Billing Code Overview
CPT code 43502 describes surgical repair by suture of a preexisting laceration involving the lower esophagus at its entry into the stomach. The procedure is performed to control bleeding from a full-thickness or mucosal tear at the gastroesophageal junction, such as a Mallory–Weiss tear resulting from severe retching or vomiting.
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Service type: Surgical repair of an esophageal laceration to achieve hemostasis
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Typical site of service: Operating room or other procedural/surgical suite capable of endoscopic or open gastrointestinal surgery
Clinical & Coding Specifications
Clinical Context
A 52-year-old male with a history of heavy alcohol use presents to the emergency department after multiple episodes of forceful vomiting and hematemesis. He is tachycardic and hypotensive with ongoing upper gastrointestinal bleeding. Initial resuscitation is performed, including IV fluids and blood transfusion as needed. An urgent upper endoscopy (esophagogastroduodenoscopy) is performed and reveals a linear mucosal tear at the gastroesophageal junction consistent with a Mallory–Weiss tear with active bleeding. The gastroenterologist places endoscopic hemostatic sutures to control hemorrhage involving the distal esophagus as it enters the stomach, corresponding to CPT 43502. Post-procedure, the patient is monitored in the recovery area or intensive care unit depending on hemodynamic stability. Documentation includes indication (hematemesis due to suspected Mallory–Weiss tear), informed consent, endoscopic findings, hemostatic technique (suturing), estimated blood loss, personnel present, and any complications. Typical sites of service include the hospital operating room, endoscopy suite, or emergency department procedure area.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when work, time, or technical difficulty substantially exceeds typical for 43502. |
23 | Unusual Anesthesia | Use when general anesthesia is medically necessary but not typical for endoscopic hemostasis. |
26 | Professional Component | Use when reporting only the physician professional component separate from facility/technical services. |
52 | Reduced Services | Use when the procedure is partially reduced or not completed as planned. |
53 | Discontinued Procedure | Use when the procedure is started but discontinued due to patient instability or unforeseen circumstances. |
62 | Two Surgeons | Use when two surgeons of different specialties work together as primary surgeons for complex control of bleeding. |
78 | Unplanned Return to the OR | Use for a related procedure for a complication or recurrence requiring a return to the operating room within the global period. |
79 | Related to Another Procedure (Note: not in provided list) | Data not available in the input. |
76 | Repeat Procedure (Note: not in provided list) | Data not available in the input. |
73 | Discontinued Outpatient Hospital/ASC Procedure Prior to Anesthesia | Use when procedure canceled after patient prepared but before anesthesia in the outpatient/ASC setting. |
80 | Assistant Surgeon | Use when an assistant surgeon is required and documented. |
81 | Minimum Assistant Surgeon | Use when a minimal assistant surgeon is documented. |
QX | Surgical Care Only (Modifier Edit: QX typically used with CRNA) | Use when only the surgical portion is billed by the practitioner per payer guidance. |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207L00000X | Gastroenterology | Gastroenterologists commonly perform endoscopic hemostasis and repair of Mallory–Weiss tears. |
208000000X | General Surgery | General surgeons may perform operative repair of esophageal/stomach lacerations in operative settings. |
363L00000X | Critical Care Medicine | Intensivists manage stabilization and post-procedure critical care for hemodynamically unstable patients. |
208D00000X | Thoracic Surgery | Thoracic surgeons may be involved for complex esophageal injuries extending beyond endoscopic repair. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
K22.6 | Mallory-Weiss syndrome | Directly describes a mucosal laceration at the gastroesophageal junction that can cause upper GI bleeding treated by 43502. |
K92.0 | Hematemesis | Symptom commonly present leading to endoscopic evaluation and potential hemostatic suturing. |
R04.0 | Epistaxis (Note: unrelated to GI bleeding) | Data not available in the input. |
K25.0 | Acute gastric ulcer with hemorrhage | Potential alternative source of upper GI bleeding considered in differential diagnosis. |
K29.01 | Acute hemorrhagic gastritis | Another potential source of upper GI bleeding that may be evaluated during endoscopy. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
43235 | Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, with or without collection of specimen(s) by brushing or washing | Performed prior to 43502 for diagnostic visualization and to locate the bleeding source. |
43255 | Endoscopic control of bleeding, esophagus, stomach, or duodenum; by injection, bipolar cautery, thermal probe, or hemostatic clips | Alternative or adjunct endoscopic hemostatic techniques that may be used instead of or in addition to suturing. |
43753 | Laparoscopy, surgical, esophagogastric fundoplasty (e.g., Nissen) (Note: different context) | May be performed if concurrent surgical repair or anti-reflux procedure is indicated during operative management. |
99152 | Anesthesia for procedures on lower abdomen, perineum and lower extremities; medium complexity (Note: anesthesia codes vary) | Represents anesthesia services that may be reported when unusual anesthesia is required for patient stability (use payer-specific rules). |
36415 | Collection of venous blood by venipuncture | Common ancillary service for pre-procedure labs and transfusion monitoring. |