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The CPT® Code 43113 refers to a surgical procedure known as a total or near total esophagectomy, which involves the complete or nearly complete removal of the esophagus. This procedure is performed through a thoracotomy, which is an incision made in the chest wall to access the thoracic cavity. Following the esophagectomy, the procedure includes the reconstruction of the esophagus using either a segment of the colon or small intestine. This reconstruction process involves several critical steps, including the mobilization and preparation of the chosen intestinal segment, as well as the creation of an anastomosis, which is a surgical connection between the intestine and the pharynx or the remaining portion of the esophagus. The choice of using colon or small intestine for reconstruction can vary based on the specific clinical scenario and the surgeon's preference. Typically, a right posterior thoracotomy is utilized to gain access to the thoracic cavity. The procedure begins with an incision through the skin and soft tissues, followed by retraction of the scapula to enter the thorax without damaging the pleura. The surgical team performs retropleural dissection to expose the esophagus, while carefully identifying and preserving critical structures such as the pneumogastric and recurrent nerves, as well as the azygous vein and bronchial artery. Once the esophagus is adequately exposed, it is freed from surrounding tissues through both blunt and sharp dissection, and then transected at the esophagogastric junction. The procedure continues with the transection of the pharynx or cervical esophagus, allowing for the complete removal of the esophagus. If a section of colon is selected for the reconstruction, careful dissection is performed to prepare the colon for use as a graft. The procedure is complex and requires meticulous attention to detail to ensure proper anastomosis and restoration of gastrointestinal continuity.
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The procedure described by CPT® Code 43113 is indicated for patients who require a total or near total esophagectomy due to various conditions affecting the esophagus. These indications may include, but are not limited to:
The procedure for CPT® Code 43113 involves several critical steps, which are detailed as follows:
After the completion of the procedure, patients typically require close monitoring in a postoperative setting. Expected recovery may involve managing pain, monitoring for any signs of complications such as anastomotic leaks, and ensuring proper nutrition through the jejunostomy tube. Patients may need to follow a specific diet and gradually transition to oral intake as tolerated. Follow-up appointments are essential to assess healing and function of the anastomosis, as well as to provide ongoing support for any nutritional needs.
| Short Descr | REMOVAL OF ESOPHAGUS | Medium Descr | TOT ESOPHG W/THORCOM W/COLON NTRPSTJ/INT RCNSTJ | Long Descr | Total or near total esophagectomy, with 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) | 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 |
| 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. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 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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