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The procedure described by CPT® Code 43288 refers to a total or near total esophagectomy, which is a surgical operation involving the removal of a significant portion of the esophagus. This procedure is performed using thoracoscopic techniques, which involve the use of a thoracoscope to access the thoracic cavity, allowing for minimally invasive surgery. The esophagus is mobilized in the upper, middle, and lower mediastinal regions, which are the spaces in the chest that contain the esophagus, trachea, heart, and major blood vessels. Additionally, a separate laparoscopic proximal gastrectomy may be performed, which involves the removal of the upper part of the stomach, and if indicated, a laparoscopic pyloric drainage procedure may also be included. The surgery may culminate in an open cervical pharyngogastrostomy or esophagogastrostomy, which are procedures that connect the remaining esophagus or the gastric conduit to the pharynx, allowing for the passage of food. This complex surgical intervention is typically indicated for patients with locally advanced esophageal cancers located in the mid to distal sections of the esophagus. The procedure requires careful positioning of the patient, typically in a left lateral position, and involves multiple surgical steps to ensure the safe and effective removal of the esophagus and reconstruction of the digestive tract. The use of thoracoscopic and laparoscopic techniques aims to minimize recovery time and postoperative complications compared to traditional open surgery.
© Copyright 2025 Coding Ahead. All rights reserved.
The procedure described by CPT® Code 43288 is indicated for the treatment of locally advanced esophageal cancers, particularly those located in the mid to distal esophagus. This surgical intervention is typically considered when the cancer has progressed to a stage where it necessitates the removal of a significant portion of the esophagus to achieve effective treatment.
The procedure begins with the patient positioned in a left lateral position, allowing for optimal access to the thoracic cavity. Thoracoscopic ports are then placed to facilitate the mobilization of the esophagus. The inferior pulmonary ligament is divided, followed by the dissection of the mediastinal pleura up to the level of the azygous vein, which is crucial for exposing the thoracic esophagus. The azygous vein is subsequently divided using vascular staples to further enhance access. The esophagus is circumferentially mobilized from the diaphragm to the thoracic outlet, utilizing a Penrose drain to assist in the mobilization process. Next, the subcarinal, paraesophageal, and pulmonary lymph nodes are dissected and removed for pathological examination, which is an important step in assessing the extent of cancer spread. After completing the thoracic portion, the instruments are removed, and the patient is repositioned supine for the abdominal phase of the procedure. Laparoscopic instruments are inserted through appropriate ports, and the gastric ligament is divided. The right and left diaphragmatic crus are identified and divided to free the gastroesophageal junction, allowing for better access to the stomach. The greater curvature of the stomach is mobilized by dividing the short gastric vessels, and care is taken to preserve the gastroepiploic arcade during the division of the gastric omentum. The stomach is then retracted anteriorly, and the posterior gastroesophageal attachments are divided. The celiac lymph nodes are completely dissected, and the left gastric vessels are divided using vascular staples. If indicated, an internal pyloroplasty is performed to facilitate gastric drainage. Following this, the stomach is tubularized into a gastric conduit using staples and sutures, preserving the right gastric vessels. A jejunostomy tube is placed prior to dividing the phrenoesophageal membrane to ensure nutritional support postoperatively. The open dissection of the neck is initiated along the anterior border of the sternocleidomastoid muscle, where the upper esophagus is carefully freed from the trachea and prevertebral fascia, with gentle dissection to protect the recurrent laryngeal nerve. With gentle traction applied from above, the esophagus and gastric conduit are delivered through the neck incision. The esophagus is then ligated and transected, and the gastric conduit is trimmed and anastomosed to the pharyngeal opening. A nasogastric tube may be inserted to maintain patency of the anastomosis. After ensuring hemostasis, drains are placed as necessary, and the neck incision is closed in layers. The abdominal cavity is inspected, and the gastric conduit may be sewn to the hiatal opening to prevent herniation. Finally, drains are placed as needed in the abdomen and lower chest, and the laparoscopic instruments are removed to complete the procedure.
Post-procedure care following a total or near total esophagectomy involves careful monitoring of the patient for any complications that may arise. Patients are typically observed for signs of infection, bleeding, or anastomotic leaks. The insertion of a nasogastric tube helps maintain the patency of the anastomosis and may be used for feeding until the patient can tolerate oral intake. Pain management is also a critical component of post-operative care, as patients may experience significant discomfort following such an extensive surgical procedure. Patients are usually encouraged to begin ambulation as soon as possible to promote recovery and reduce the risk of thromboembolic events. Nutritional support is essential, and dietary modifications may be necessary as the patient transitions back to oral feeding. Follow-up appointments are scheduled to monitor the healing process and assess the effectiveness of the surgery in managing the esophageal cancer. Additionally, any drains placed during the procedure are monitored and managed appropriately until they can be safely removed.
| Short Descr | ESPHG THRSC MOBLJ | Medium Descr | ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ | Long Descr | Esophagectomy, total or near total, with thoracoscopic mobilization of the upper, middle, and lower mediastinal esophagus, with separate laparoscopic proximal gastrectomy, with laparoscopic pyloric drainage procedure if performed, with open cervical pharyngogastrostomy or esophagogastrostomy (ie, thoracoscopic, laparoscopic and cervical incision esophagectomy, McKeown esophagectomy, tri-incisional 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) |
| 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). | 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. | 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). | 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). | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner |
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| 2018-01-01 | Added | Code Added. |