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Esophagoplasty is a surgical procedure that involves the plastic repair or reconstruction of the esophagus, which is the muscular tube that connects the throat to the stomach. This procedure is typically indicated for various conditions that may compromise the integrity of the esophagus, such as blunt trauma, avulsion injuries, or the presence of a tracheoesophageal fistula, which is an abnormal connection between the trachea and esophagus. The surgery is performed through a cervical approach, meaning that an incision is made in the neck, usually on the left side, to access the esophagus directly. During the procedure, critical structures such as the internal jugular vein and carotid artery are carefully identified and retracted to provide a clear view of the trachea and esophagus. The surgeon then makes an incision in the cervical esophagus, either above or below the lesion, to facilitate the repair. The esophagus is meticulously dissected from surrounding tissues to allow for thorough inspection and repair of any defects. This may involve debriding any damaged or necrotic tissue and trimming the mucosal tissue until healthy tissue is reached. The mucosal layer is then inverted and sutured, followed by a layered closure of the muscular wall of the esophagus. In cases where a tracheoesophageal fistula is present, as indicated by CPT® Code 43305, the fistula is identified, divided, and the trachea is repaired with sutures. The esophageal defect is closed in layers, and additional support may be provided using pedicle flaps from nearby muscles to reinforce the closure, ensuring a robust repair of the esophagus and trachea.
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Esophagoplasty with repair of tracheoesophageal fistula is indicated for the following conditions:
The procedure for esophagoplasty with repair of tracheoesophageal fistula involves several critical steps:
Post-procedure care for patients undergoing esophagoplasty with repair of tracheoesophageal fistula typically includes monitoring for complications such as infection, leakage at the surgical site, or respiratory issues. Patients may require a period of fasting followed by gradual reintroduction of oral intake, depending on the surgeon's assessment of the repair's integrity. Follow-up visits are essential to evaluate healing and ensure that the esophagus and trachea are functioning properly. Additional imaging studies may be performed to assess the success of the repair and to monitor for any potential complications.
| Short Descr | REPAIR ESOPHAGUS AND FISTULA | Medium Descr | ESPHGP CRV APPR W/RPR TRACHEOESOPHGL FSTL | Long Descr | Esophagoplasty (plastic repair or reconstruction), cervical approach; with repair of tracheoesophageal fistula | 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 |
| 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.) | 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 |
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| 2003-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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