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The CPT® Code 43108 refers to a surgical procedure known as a total or near total esophagectomy, which is performed without a thoracotomy (chest incision). This procedure involves the removal of the esophagus and the reconstruction of the digestive tract using either a segment of the colon or small intestine. The term "esophagectomy" specifically denotes the excision of the esophagus, which is the tube that carries food from the throat to the stomach. The reconstruction is achieved through anastomosis, which is the surgical connection of two structures, in this case, the remaining portion of the esophagus or the pharynx to the grafted segment of the colon or small intestine. The procedure is characterized by its complexity and the need for careful mobilization and preparation of the intestinal graft. The choice between using the colon or small intestine for reconstruction depends on various factors, including the patient's anatomy and the extent of the disease affecting the esophagus. The approach used is typically transhiatal, meaning that the surgery is performed through an incision in the upper abdomen rather than through the chest, which helps to minimize complications such as mediastinitis, an infection that can occur following esophageal surgery. During the procedure, the surgeon will explore the peritoneal cavity, mobilize the stomach, and prepare the graft for anastomosis. The careful dissection and preservation of blood vessels are crucial to ensure adequate blood supply to the graft. The overall goal of this procedure is to restore the continuity of the digestive tract while minimizing the risk of complications and ensuring the best possible outcome for the patient.
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The procedure described by CPT® Code 43108 is indicated for patients with conditions that necessitate the removal of the esophagus, which may include the following:
The procedure for CPT® Code 43108 involves several critical steps, each essential for the successful completion of the esophagectomy and reconstruction:
After the completion of the esophagectomy and reconstruction, patients typically require careful monitoring and management. Post-procedure care includes monitoring for complications such as anastomotic leaks, infection, and respiratory issues. Patients may experience a period of recovery where they are gradually introduced to oral intake, often starting with clear liquids before progressing to a soft diet. The jejunostomy tube will be used for feeding until the patient can tolerate oral nutrition. Follow-up appointments are essential to assess healing and ensure that the anastomosis is functioning properly. Additionally, patients may require nutritional support and counseling to adapt to changes in their digestive system following the surgery.
| Short Descr | REMOVAL OF ESOPHAGUS | Medium Descr | TOT ESOPHG W/O THORCOM COLON NTRPSTJ/INT RCNSTJ | Long Descr | Total or near total esophagectomy, without thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation and anastomosis(es) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 94 - Other OR upper GI therapeutic procedures |
| 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2002-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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