© Copyright 2025 American Medical Association. All rights reserved.
The procedure described by CPT® Code 43123 is a partial esophagectomy, which involves the surgical removal of a portion of the esophagus. This operation can be performed using either a thoracoabdominal or an abdominal approach, and it may include a proximal gastrectomy, which is the removal of the upper part of the stomach. The procedure is characterized by the use of colon interposition or small intestine reconstruction, which entails mobilizing and preparing a segment of the colon or small intestine to create an anastomosis, or surgical connection, to the pharynx or the remaining portion of the esophagus. The choice of using colon or small intestine for reconstruction depends on various factors, including the extent of the esophageal disease and the specific anatomical considerations of the patient. In the thoracoabdominal approach, a median sternotomy is performed, which involves making an incision down the center of the chest and extending it into the upper abdomen. This allows the surgeon to access the esophagus and free it from surrounding tissues. Alternatively, the abdominal (transhiatal) approach may be utilized, where the stomach is mobilized, and the diaphragm is split to expose the lower posterior mediastinum and the esophagus. The esophagus is then transected near the junction with the stomach, and in some cases, a portion of the stomach may also need to be excised to ensure complete removal of any malignancy. The procedure is complex and requires careful planning and execution, particularly when determining the appropriate length of the colon graft needed for reconstruction. The mobilization of the colon or small intestine is critical, as is the preservation of blood supply to ensure the viability of the graft. The final steps involve creating an anastomosis between the thoracic esophagus and the graft, securing the graft in place, and restoring continuity to the remaining colon. A jejunostomy tube is typically placed to facilitate feeding and decompression during the recovery phase.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 43123 is indicated for patients with conditions that necessitate the surgical removal of a portion of the esophagus. These conditions may include, but are not limited to, the following:
The procedure involves several critical steps, which are detailed as follows:
Post-procedure care involves monitoring the patient for complications such as anastomotic leaks, infection, and gastrointestinal function. Patients may require nutritional support through the jejunostomy tube until they can resume oral intake. Follow-up imaging may be necessary to assess the integrity of the anastomosis and the overall recovery of the gastrointestinal tract. Pain management and gradual mobilization are also important components of post-operative care to promote healing and recovery.
| Short Descr | PARTIAL REMOVAL OF ESOPHAGUS | Medium Descr | PRTL ESPHG THORACOABDL/ABDL APPR NTRPSTJ/RCNSTJ | Long Descr | Partial esophagectomy, thoracoabdominal or abdominal approach, 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) | 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 |
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). | 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. | 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.) | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2002-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
Get instant expert-level medical coding assistance.