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The CPT® Code 43287 refers to a complex surgical procedure known as a distal two-thirds esophagectomy, which is performed using laparoscopic techniques. This procedure involves the removal of the distal two-thirds of the esophagus, which is the muscular tube that connects the throat to the stomach, and is typically indicated for patients suffering from esophageal disease or resectable malignant tumors located in the middle to lower third of the esophagus and the gastroesophageal junction. The surgery is characterized by the laparoscopic mobilization of both the abdominal and lower mediastinal esophagus, as well as a proximal gastrectomy, which is the surgical removal of the upper portion of the stomach. If necessary, a laparoscopic pyloric drainage procedure may also be performed during this operation. In addition to the laparoscopic approach, the procedure includes a separate thoracoscopic mobilization of the middle and upper mediastinal esophagus, which involves accessing the esophagus through the chest cavity. This is followed by a thoracic esophagogastrostomy, where the remaining esophagus is connected to the gastric conduit that has been created from the stomach. The use of laparoscopic and thoracoscopic techniques allows for minimally invasive access, which can lead to reduced recovery times and less postoperative pain compared to traditional open surgery. Overall, this procedure is a critical intervention for managing significant esophageal conditions and requires a high level of surgical expertise.
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The procedure described by CPT® Code 43287 is indicated for the following conditions:
The procedure begins with the insertion of laparoscopic instruments through designated ports in the abdomen. The gastric ligament is divided to facilitate access, followed by the identification and division of the right and left diaphragmatic crus, which helps to free the gastroesophageal junction. The greater curvature of the stomach is then mobilized by dividing the short gastric vessels, allowing for better visualization and access to the stomach. Care is taken to preserve the gastroepiploic arcade during the division of the gastric omentum. The stomach is retracted anteriorly, and the posterior gastroesophageal attachments are carefully divided to further mobilize the stomach. Next, the celiac lymph nodes are completely dissected, and the left gastric vessels are divided using vascular staples to ensure proper blood supply management. If indicated, an internal pyloroplasty is performed to facilitate gastric drainage. The stomach is then tubularized into a gastric conduit using staples and sutures, starting from the lesser curvature toward the fundus while preserving the right gastric vessels. Prior to dividing the phrenoesophageal membrane, a jejunostomy tube is placed to assist with postoperative feeding. After the abdominal portion is completed, the instruments are removed, and the abdominal incisions are closed. The patient is then repositioned to the left lateral position, and the chest is prepped and draped for the thoracoscopic portion of the procedure. Thoracic laparoscopic ports are placed, and instruments are inserted to access the thoracic cavity. The inferior pulmonary ligament is divided, followed by the mediastinal pleura to the level of the azygous vein, which exposes the thoracic esophagus. The azygous vein is divided using vascular staples to facilitate further mobilization of the esophagus. The esophagus is circumferentially mobilized from the diaphragm to just below the carina using a Penrose drain, and mediastinal lymph nodes are dissected and removed for pathological examination. The distal esophagus and the previously constructed gastric conduit are then brought up into the chest. The proximal esophagus is transected above the azygous vein, and the intercostal port space is enlarged to allow for the removal of the lower esophagus and any redundant portion of the gastric conduit. Finally, the gastric conduit and the remaining esophagus are anastomosed to complete the procedure.
Post-procedure care involves monitoring the patient for any complications related to the surgery, such as bleeding or infection. Patients may require a period of hospitalization for recovery, during which they will be assessed for their ability to tolerate oral intake. Nutritional support may be provided through the jejunostomy tube until the patient can resume normal eating. Follow-up appointments will be necessary to monitor the surgical site and ensure proper healing. Additionally, pathology results from the dissected lymph nodes will be reviewed to determine any further treatment needs, such as chemotherapy or radiation therapy, depending on the findings.
| Short Descr | ESPHG DSTL 2/3 W/LAPS MOBLJ | Medium Descr | ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ | Long Descr | Esophagectomy, distal two-thirds, with laparoscopic mobilization of the abdominal and lower mediastinal esophagus and proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with separate thoracoscopic mobilization of the middle and upper mediastinal esophagus and thoracic esophagogastrostomy (ie, laparoscopic thoracoscopic esophagectomy, Ivor Lewis 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) | none | MUE | 1 |
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) |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | 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. | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 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). | 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. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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.) | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area |
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| 2018-01-01 | Added | Code Added. |
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