CPT Code 43130 — Diverticulectomy of Pharynx or Cervical Esophagus

Code Descriptor

43130 — Diverticulectomy of pharynx or cervical esophagus; without myotomy

This CPT code describes the surgical excision (diverticulectomy) of a diverticulum — an outpouching or herniation of mucosa — arising from the posterior pharynx or cervical (upper) esophagus, performed without a concomitant myotomy (muscle-cutting procedure). This is performed via an open cervical approach, with the neck incised to access the posterior hypopharyngeal or cricopharyngeal region. The diverticular sac is identified, dissected free from surrounding tissue, ligated at its neck, and excised. The mucosal defect is then closed primarily. This is the most common approach for a Zenker’s diverticulum (pharyngoesophageal diverticulum) when cricopharyngeal myotomy is not simultaneously performed or when the diverticulum originates from the lateral pharyngeal wall.

Companion Code

CPT	Description
43135	Diverticulectomy of pharynx or cervical esophagus; with myotomy

43135 is the preferred code when cricopharyngeal myotomy is performed at the same operative session to relieve the underlying pharyngeal outflow obstruction — the most physiologically complete treatment for Zenker’s diverticulum. Do not separately report a myotomy code in addition to 43135; it is bundled into the descriptor.

Anatomy & Clinical Context

A pharyngoesophageal diverticulum (Zenker’s diverticulum) is the most common type of esophageal diverticulum and arises in Killian’s triangle — a triangular area of relative muscular weakness at the posterior pharyngeal wall between the oblique fibers of the inferior pharyngeal constrictor and the transverse fibers of the cricopharyngeus muscle. Increased hypopharyngeal pressure due to a poorly relaxing cricopharyngeal muscle results in progressive mucosal herniation through this dehiscence. Over time, the sac enlarges inferiorly, often displacing to the left side of the neck behind the cervical esophagus.

True vs. Pulsion Diverticula:

Zenker’s diverticulum is a pulsion-type, false diverticulum (only mucosa and submucosa herniate — no muscularis propria) caused by high intraluminal pressure.
Lateral cervical (Killian-Jamieson) diverticulum arises below the cricopharyngeus, also in the cervical esophagus, and is far less common.
Mid-esophageal diverticula (traction type) and epiphrenic diverticula are coded differently and approached via thoracotomy/thoracoscopy.

Operative Technique (Open Cervical Diverticulectomy without Myotomy):

Patient positioned supine with neck hyperextended.
Left oblique cervical incision anterior to the sternocleidomastoid muscle.
Dissection through platysma; retraction of SCM and carotid sheath laterally; thyroid and larynx retracted medially.
Identification of the diverticular sac, usually arising posteriorly from the pharyngoesophageal junction.
Careful dissection of the sac from surrounding adventitia to its neck at the pharyngeal wall.
Passage of a bougie or esophagoscope to stent the lumen and prevent injury.
Stapling or suture ligation of the neck; excision of the sac.
Primary mucosal closure, drain placement if warranted, wound closure.

wRVU & Reimbursement

Component	Value
wRVU	14.24
Work RVU (CMS 2024)	14.24
Assistant Surgeon	✅ Yes — payable
Co-Surgery	✅ Permitted
Team Surgery	✅ Permitted
Bilateral Surgery	❌ Not applicable
Global Period	90 days
Facility Only	No — payable in facility and non-facility settings

The 90-day global surgical period includes all routine pre- and post-operative care. Separate E/M services during this period require modifier -24 (unrelated condition) or -25 (significant, separately identifiable, same day, pre-procedure). Complications requiring return to the OR during the global period may be reported with modifier -78.

Modifiers Commonly Used

Modifier	Reason
-50	Not applicable (bilateral anatomy not relevant)
-22	Increased procedural services — use when complexity is substantially greater (giant sac, hostile neck, prior surgery)
-52	Reduced services — if procedure is partially performed
-62	Co-surgery with another qualified surgeon
-80	Assistant surgeon (payable)
-AS	PA/NP/CRNA assistant at surgery
-78	Return to OR during global period for complication
-59	Distinct procedural service when billing with related procedures

Common ICD-10-CM Diagnosis Codes

K22.5 — Diverticulum of Esophagus, Acquired

Description: Acquired outpouching or herniation of one or more layers of the esophageal wall, including pharyngoesophageal (Zenker’s), epiphrenic, and mid-esophageal diverticula. This is the primary diagnosis code for Zenker’s diverticulum.

HCC: ❌ Not an HCC-mapped diagnosis
POA (Present on Admission): Required for inpatient reporting
MCC/CC Status: Neither MCC nor CC for MS-DRG purposes
Clinical correlation: Use for all acquired diverticula including Zenker’s, Killian-Jamieson, traction diverticula

Includes: Epiphrenic diverticulum, Zenker’s diverticulum, pharyngoesophageal diverticulum, pulsion diverticulum of esophagus

Excludes 1: Congenital diverticulum of esophagus (Q39.6)

Excludes 2: (none)

Q39.6 — Congenital Diverticulum of Esophagus

Description: A diverticulum present from birth due to embryological maldevelopment of the esophageal wall. Far less common than acquired diverticula. Used when the diverticulum is documented as congenital in origin.

HCC: ❌ Not an HCC-mapped diagnosis
POA: Required
MCC/CC Status: Neither

K22.8 — Other Specified Diseases of Esophagus

Description: Catch-all for documented esophageal conditions not captured by more specific codes. May be used if the documentation describes a lateral pharyngeal diverticulum or Killian-Jamieson diverticulum that does not clearly fall under K22.5.

HCC: ❌ Not an HCC-mapped diagnosis

K22.0 — Achalasia of Cardia

Description: Used when there is concurrent achalasia documented in addition to diverticular disease. Not typically the primary code for Zenker’s repair unless achalasia is the overriding clinical condition driving the encounter.

HCC: ❌ Not an HCC-mapped diagnosis

R13.10 — Dysphagia, Unspecified / R13.11-R13.19 — Dysphagia by Phase

Description: Symptom codes for difficulty swallowing. Used as secondary/additional codes to describe presenting symptoms when dysphagia is separately documented and not fully explained by the primary diagnosis, or as the primary code when the etiology has not yet been confirmed.

HCC: ❌ Not HCC-mapped
Note: If dysphagia is the reason for the procedure (e.g., evaluation-and-management before definitive diagnosis), it may serve as principal diagnosis. Once the diverticulum is confirmed, K22.5 takes priority.

Code	Description
R13.11	Dysphagia, oral phase
R13.12	Dysphagia, oropharyngeal phase
R13.13	Dysphagia, pharyngeal phase
R13.14	Dysphagia, pharyngoesophageal phase
R13.19	Other dysphagia

J69.0 — Pneumonitis Due to Inhalation of Food and Vomit

Description: Used as a secondary code when aspiration pneumonia or pneumonitis is documented as a complication or associated condition due to regurgitation from a pharyngeal diverticulum.

HCC: ❌ Not HCC-mapped
CC/MCC Status: ✅ CC — impacts MS-DRG assignment

MS-DRG Assignment

CPT codes are primarily used in the outpatient/physician billing setting. For inpatient hospital stays, MS-DRG assignment is driven by ICD-10-PCS procedure codes and ICD-10-CM diagnoses. The CPT code 43130 corresponds to the following ICD-10-PCS procedure when performed inpatient.

ICD-10-PCS Equivalent (Approximate):

0DB10ZZ — Excision of Upper Esophagus, Open Approach (or cervical esophagus subdivision)
0DB20ZZ — Excision of Middle Esophagus, Open Approach (if applicable)

Likely MS-DRG Groupings (Principal Dx: K22.5):

MS-DRG	Description	GMLOS
326	Stomach, Esophageal and Duodenal Procedures with MCC	10.4
327	Stomach, Esophageal and Duodenal Procedures with CC	5.9
328	Stomach, Esophageal and Duodenal Procedures without CC/MCC	3.1

The presence of a CC (e.g., aspiration pneumonitis J69.0, malnutrition E43, COPD J44.x) or MCC (e.g., aspiration pneumonia with organism, respiratory failure J96.x, sepsis A41.x) dramatically affects reimbursement. Ensure thorough query and documentation capture for all comorbid conditions.

Code Tree — CPT Esophagus Excision (43100-43135)

Digestive System — Esophagus 
└── Excision 
   ├── 43100 — Excision of lesion, esophagus; cervical approach, with primary repair 
   ├── 43101 — Excision of lesion, esophagus; thoracic or abdominal approach, with primary repair 
   ├── 43107 — Total or near total esophagectomy, without thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (transhiatal) 
   ├── 43108 — Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction 
   ├── 43112 — Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty 
   ├── 43113 — Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction 
   ├──  43116  — Partial esophagectomy, cervical, with free intestinal graft 
   ├──  43117  — Partial esophagectomy, distal two-thirds with thoracotomy and separate abdominal incision; with or without proximal gastrectomy 
   ├──  43118  — Partial esophagectomy, distal two-thirds with thoracotomy and separate abdominal incision; with colon interposition or small intestine reconstruction 
   ├──  43121  — Partial esophagectomy, distal two-thirds with thoracotomy only    ├──  43122  — Partial esophagectomy, thoracoabdominal or abdominothoracic approach; with or without proximal gastrectomy 
   ├──  43123  — Partial esophagectomy, thoracoabdominal or abdominothoracic approach; with colon interposition or small intestine reconstruction 
   ├──  43124  — Total or partial esophagectomy, without reconstruction (any approach) 
   ├──  43130  ◄◄ Diverticulectomy of pharynx or cervical esophagus; WITHOUT myotomy 
   └──  43135  — Diverticulectomy of pharynx or cervical esophagus; WITH myotomy

Includes

Open surgical excision of a pharyngeal diverticulum (including Zenker’s diverticulum) via cervical approach
Open surgical excision of a cervical esophageal diverticulum
Killian-Jamieson diverticulum excision (arising just below the cricopharyngeus, anterolaterally)
Ligation and excision of the diverticular sac
Primary mucosal and submucosal closure of the diverticular neck
Intraoperative esophagoscopy to guide dissection (do not separately report)
Routine drain placement and wound closure

Excludes / Do Not Report Separately

43135 — If myotomy is performed at the same session, use 43135 instead, NOT 43130 + a myotomy code
Endoscopic diverticulotomy / Dohlman procedure — Reported with 43180 (endoscopic diverticulotomy of hypopharyngeal diverticulum, rigid or flexible esophagoscope) — do not use 43130 for endoscopic approaches
Esophagoscopy (43191-43232) — Diagnostic or therapeutic esophagoscopy performed at the same session is typically bundled (NCCI edits); report separately only if a distinct, separately identifiable diagnostic esophagoscopy was performed at a separate session or if a significant additional therapeutic procedure was rendered
Cricopharyngeal myotomy alone — If performed without diverticulectomy, see 43030
Mid-esophageal or epiphrenic diverticulectomy — These require thoracic or laparoscopic/thoracoscopic approaches; coded differently (see 43334, 43335, 43336, 43337)
Laryngoscopy — Do not report separately if only used for airway management
Tracheotomy — Report separately if performed and documented as medically necessary (31600, 31603)

NCCI (National Correct Coding Initiative) Considerations

Esophagoscopy codes (43191, 43200) are often bundled with 43130 via NCCI edits; modifier -59 or -XU may be required to unbundle if distinctly separate and medically necessary
43030 (cricopharyngeal myotomy) — Do not report with 43130; if myotomy is performed, use 43135
Anesthesia is not separately reported by the operating surgeon

Coding Examples

Example 1 — Straightforward Zenker’s Diverticulectomy, Outpatient ASC

A 72-year-old male presents with a 3-year history of progressive dysphagia, regurgitation of undigested food, halitosis, and a gurgling sensation in the neck. Upper GI series confirms a 4 cm Zenker’s diverticulum. He is taken to the OR for open cervical diverticulectomy. The surgeon excises the diverticular sac and closes the pharyngeal mucosa without performing a cricopharyngeal myotomy.

Report: 43130 Diagnosis: K22.5 (Diverticulum of esophagus, acquired) Secondary Dx: R13.14 (Dysphagia, pharyngoesophageal phase)

Example 2 — Diverticulectomy WITH Myotomy (Correct Code Selection)

Same clinical scenario as above; however, the surgeon notes the cricopharyngeal bar is hypertrophied and proceeds to perform a cricopharyngeal myotomy after excising the diverticular sac.

Report: 43135 (NOT 43130) Diagnosis: K22.5 Secondary Dx: R13.14

⚠️ Common Coding Error: Reporting 43130 + 43030 together. This is incorrect. When myotomy accompanies diverticulectomy via the same cervical approach, only 43135 is reported.

Example 3 — Inpatient with Aspiration Pneumonitis

A 68-year-old female is admitted with aspiration pneumonitis in the setting of a known Zenker’s diverticulum. After pulmonary stabilization, she undergoes open cervical diverticulectomy without myotomy on hospital day 3.

Report (Physician): 43130 Principal Diagnosis (Inpatient): K22.5 Secondary Diagnoses: J69.0 (Aspiration pneumonitis), E11.9 (T2DM if applicable), additional comorbidities per documentation

MS-DRG: Likely 327 (with CC from J69.0) or 326 (if MCC-level comorbidity documented)

Example 4 — Large Diverticulum with Increased Complexity

A 78-year-old male with prior cervical spine surgery (anterior approach, C4-C5) undergoes open cervical diverticulectomy for a 7 cm Zenker’s diverticulum. The prior spinal hardware significantly increased dissection time and difficulty. Total operative time was 3.5 hours.

Report: 43130-22 (with detailed operative note documenting increased complexity) Diagnosis: K22.5 Secondary Dx: Z96.641 or relevant implant/status code for cervical hardware Note: Supporting documentation must justify modifier -22; include a separate cover letter to payer with operative report

Example 5 — Assistant Surgeon Billing

The same procedure is performed with a qualified assistant surgeon scrubbed in due to complexity.

Operating Surgeon: 43130 (no modifier) Assistant Surgeon: 43130-80 (If PA/NP assistant: 43130-AS)

Documentation Tips for Optimal Coding & Reimbursement

Clearly document location of the diverticulum (pharyngeal vs. cervical esophageal vs. mid-esophageal vs. epiphrenic) — this determines the CPT code
Document whether myotomy was or was not performed — this determines 43130 vs. 43135
Document the approach (open cervical vs. endoscopic/transoral) — endoscopic approaches use 43180, NOT 43130
Document all comorbidities (aspiration history, malnutrition, GERD, COPD, DM) to support CC/MCC capture for MS-DRG optimization
If complexity modifier -22 is used, the operative note must explicitly state the reason for increased difficulty
For inpatient cases, ensure ICD-10-PCS procedure codes align with the correct approach (Open = character 0) and root operation (Excision = B)

CPT	Description
43030	Cricopharyngeal myotomy (without diverticulectomy)
43135	Diverticulectomy of pharynx or cervical esophagus; with myotomy
43180	Endoscopic diverticulotomy of hypopharyngeal diverticulum (Dohlman)
43191	Esophagoscopy, rigid; diagnostic
43200	Esophagoscopy, flexible; diagnostic
43215	Esophagoscopy, flexible; with removal of foreign body
43334	Repair, paraesophageal hiatal hernia (with or without fundoplasty); open
43280	Laparoscopic Nissen fundoplication

Quick Reference Summary

Field	Detail
CPT	43130
Full Descriptor	Diverticulectomy of pharynx or cervical esophagus; without myotomy
Approach	Open, cervical
wRVU	14.24
Global Period	90 days
Assistant Payable	✅ Yes
Primary ICD-10	K22.5
HCC	❌ None applicable
MS-DRG	326 / 327 / 328
Commonly Confused With	43135 (with myotomy), 43180 (endoscopic)
Do NOT Bundle	43030, 43135

Explorer

43130