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The procedure described by CPT® Code 43121 involves a partial esophagectomy, specifically targeting the distal two-thirds of the esophagus. This surgical intervention is performed through a thoracotomy, which is an incision made in the chest wall to access the thoracic cavity. The procedure may also include a proximal gastrectomy, which is the surgical removal of the upper portion of the stomach, and a thoracic esophagogastrostomy, where the esophagus is surgically connected to the stomach. Additionally, a pyloroplasty, which is a surgical procedure to widen the opening of the pylorus (the outlet of the stomach), may be performed, although it is not mandatory. In this procedure, a right posterior thoracotomy is typically utilized, allowing the surgeon to access the esophagus while minimizing disruption to the surrounding structures. The operation begins with an incision through the skin and soft tissues, followed by retraction of the scapula to enter the thoracic cavity without damaging the pleura. The surgeon performs retropleural dissection to expose the esophagus, identifying critical anatomical structures such as the pneumogastric and recurrent nerves, the azygous vein, and the bronchial artery. The esophagus is then carefully dissected from surrounding tissues, and the stomach is mobilized by splitting the diaphragmatic hiatus. The esophagus is transected near the esophagogastric junction, and if necessary, a portion of the stomach may also be excised to ensure complete removal of any malignancy. Following the removal of the esophagus, a gastric tube is created from the stomach, and specific arteries are ligated and divided to facilitate the procedure. If a pyloroplasty is indicated, the pylorus is surgically modified to enhance the passage into the duodenum. The final steps involve mobilizing the gastric tube into the mediastinum and performing an anastomosis between the gastric tube and the remaining thoracic esophagus, ensuring continuity of the digestive tract.
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The procedure described by CPT® Code 43121 is indicated for patients with specific conditions affecting the esophagus. These indications may include:
The procedure for CPT® Code 43121 involves several critical steps, which are detailed as follows:
Post-procedure care following a partial esophagectomy involves monitoring the patient for complications such as infection, bleeding, or anastomotic leaks. Patients may require a period of hospitalization for recovery, during which they will be closely observed. Nutritional support may be necessary, as patients may initially be unable to consume food orally. Gradual reintroduction of diet will be guided by the surgical team based on the patient's recovery progress. Follow-up appointments will be scheduled to assess healing and to monitor for any recurrence of disease or complications related to the surgery.
| Short Descr | PARTIAL REMOVAL OF ESOPHAGUS | Medium Descr | PRTL ESOPHAGEC W/WO PROX GASTREC/PYLOROPLASTY | Long Descr | Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without proximal gastrectomy, with thoracic esophagogastrostomy, with or without pyloroplasty | 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 |
| 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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). | 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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| 1995-01-01 | Added | First appearance in code book in 1995. |
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