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A total or near total esophagectomy, with thoracotomy, is a surgical procedure that involves the complete or nearly complete removal of the esophagus, which is the tube that carries food from the throat to the stomach. This procedure is typically performed in cases where there is a need to address severe esophageal conditions, such as cancer or significant damage to the esophagus. The term 'thoracotomy' refers to the surgical incision made in the chest wall to access the thoracic cavity, allowing the surgeon to reach the esophagus effectively. In this context, the procedure may be categorized as a McKeown esophagectomy or a tri-incisional esophagectomy, both of which are specific techniques used to perform the esophagectomy. During the operation, a right posterior thoracotomy is commonly utilized, which involves making an incision on the right side of the back to gain access to the thoracic cavity. The surgical process includes careful dissection to expose the esophagus while preserving critical structures such as the pneumogastric and recurrent nerves, which are essential for normal gastrointestinal function. The procedure also involves the creation of a gastric tube from the stomach, which serves as a new pathway for food to enter the digestive system after the esophagus has been removed. Additional steps may include the ligation and division of specific blood vessels to ensure proper blood supply to the remaining stomach tissue. If necessary, a pyloroplasty may be performed to facilitate the passage of food into the duodenum. Overall, this complex surgical intervention is designed to restore gastrointestinal continuity and function following the removal of the esophagus.
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The total or near total esophagectomy with thoracotomy is indicated for various severe esophageal conditions. These may include:
The procedure for a total or near total esophagectomy with thoracotomy involves several critical steps, which are detailed as follows:
Post-procedure care following a total or near total esophagectomy with thoracotomy involves careful monitoring and management of the patient’s recovery. Patients can expect to stay in the hospital for several days to ensure proper healing and to monitor for any complications. Nutritional support is critical, as patients may initially be unable to eat normally. A feeding tube may be placed to provide necessary nutrition until the anastomosis heals. Pain management is also an essential component of post-operative care, as patients may experience significant discomfort following the surgery. Regular follow-up appointments will be necessary to assess recovery and to monitor for any signs of complications, such as leaks at the anastomosis site or infections.
| Short Descr | ESPHG TOT W/THRCM | Medium Descr | TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY | Long Descr | Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy or cervical esophagogastrostomy, with or without pyloroplasty (ie, McKeown esophagectomy or tri-incisional esophagectomy) | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 |
This is a primary code that can be used with these additional add-on codes.
| 32674 | Add-on Code MPFS Status: Active Code APC C Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) | 38746 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 2018-01-01 | Changed | Long and short descriptions changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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