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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 or function of the esophagus, such as blunt trauma, avulsion injuries, or complications arising from tracheoesophageal fistulas. The thoracic approach to esophagoplasty generally involves a right posterolateral thoracotomy, which is a surgical incision made in the chest to access the esophagus. During this approach, the skin is incised, and the incision is extended through the underlying soft tissues. The scapula is retracted to allow entry into the thoracic cavity without disrupting the pleura, which is the membrane surrounding the lungs. Once inside, retropleural dissection is performed to retract the lung and expose the esophagus adequately. The mediastinal pleura may be opened as necessary to fully visualize and access the defect in the esophagus. In the context of CPT® Code 43310, the procedure specifically addresses the repair of esophageal defects that do not involve a tracheoesophageal fistula. The surgical team dissects the esophagus free from surrounding tissues to inspect and repair the defect. Any damaged or necrotic tissue within the muscular wall of the esophagus is carefully debrided, and the mucosal defect is exposed. The mucosal tissue is then trimmed back to healthy tissue, inverted, and sutured to facilitate proper healing. A second layer of sutures is applied to the muscular wall of the esophagus to ensure a robust repair. Additionally, the repair may be reinforced using microvascular anastomosis of an intercostal muscle flap, enhancing the structural integrity of the esophagus post-repair.
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The esophagoplasty procedure, specifically coded as CPT® 43310, is indicated for the following conditions:
The esophagoplasty procedure involves several critical steps to ensure effective repair of the esophagus:
Post-procedure care following an esophagoplasty coded as CPT® 43310 typically involves monitoring for complications such as infection or leakage at the repair site. Patients may require a modified diet initially, transitioning from liquids to soft foods as healing progresses. Follow-up appointments are essential to assess the integrity of the repair and ensure proper recovery. Additional considerations may include pain management and respiratory support, given the thoracic approach of the surgery.
| Short Descr | REPAIR OF ESOPHAGUS | Medium Descr | ESPHGP THRC APPR W/O RPR TRACHEOESOPHGL FSTL | Long Descr | Esophagoplasty (plastic repair or reconstruction), thoracic approach; without 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 |
| 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). | 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 | 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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| 2003-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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