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The procedure described by CPT® Code 43118 is a complex surgical intervention known as a partial esophagectomy, specifically targeting the distal two-thirds of the esophagus. This procedure is performed through a thoracotomy, which involves making an incision in the chest, and a separate abdominal incision, allowing access to both the thoracic and abdominal cavities. The surgery may be conducted with or without a proximal gastrectomy, which is the partial removal of the stomach. A key aspect of this procedure is the reconstruction of the esophagus, which can be achieved using either a segment of the colon or small intestine. This involves mobilizing and preparing the chosen segment of intestine, followed by creating an anastomosis, or surgical connection, to either the pharynx or the remaining portion of the esophagus. The surgical approach typically includes a right posterior thoracotomy, where the skin is incised, and the incision is extended through the soft tissues to access the thoracic cavity. The procedure requires careful dissection to expose the esophagus while preserving critical structures such as the pneumogastric and recurrent nerves, as well as the azygous vein and bronchial artery. The esophagus is meticulously freed from surrounding tissues, and a separate incision in the abdomen allows for exploration of the peritoneal cavity and mobilization of the stomach. The esophagus is then transected near the esophagogastric junction, and if necessary, a portion of the stomach may also be excised to ensure complete removal of any malignancy. The choice of using a section of colon or small intestine for reconstruction depends on various factors, including the extent of the disease and the specific anatomy of the patient. The procedure is intricate, requiring precise measurements and careful handling of vascular structures to ensure adequate blood supply to the graft. Following the anastomosis, a jejunostomy tube is placed to facilitate feeding and decompression, highlighting the complexity and the need for meticulous surgical technique in this procedure.
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The procedure described by CPT® Code 43118 is indicated for patients with conditions affecting the esophagus that may require surgical intervention. These indications include:
The procedure involves several critical steps, each essential for the successful completion of the partial esophagectomy:
After the completion of the partial esophagectomy, patients typically require close monitoring in a postoperative setting. Expected recovery includes managing pain, monitoring for any signs of complications such as infection or anastomotic leaks, and ensuring proper nutrition through the jejunostomy tube. Patients may need to stay in the hospital for several days to ensure adequate recovery and to begin transitioning to oral intake as tolerated. Follow-up care is essential to assess the healing of the anastomosis and to monitor for any long-term complications related to the surgery.
| Short Descr | PARTIAL REMOVAL OF ESOPHAGUS | Medium Descr | PRTL ESOPH DSTL W/WO PROX GASTRC W/COLON NTRPSTJ | Long Descr | Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; 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 |
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) |
| 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. | 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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