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The procedure described by CPT® Code 43330 is known as esophagomyotomy, specifically of the Heller type, and is performed via an abdominal approach. This surgical intervention is primarily indicated for the treatment of esophageal achalasia, a condition characterized by the inability of the esophageal sphincter to relax properly. This dysfunction leads to uncoordinated contractions within the thoracic esophagus, resulting in significant difficulty swallowing (dysphagia) and a functional obstruction of the esophagus. The Heller myotomy aims to alleviate these symptoms by surgically cutting the muscle fibers of the lower esophageal sphincter, thereby allowing for improved passage of food from the esophagus into the stomach. The abdominal approach, also referred to as a transhiatal approach, involves making an incision in the upper abdomen to access the peritoneal cavity. This method allows for the mobilization of the stomach at the gastroesophageal junction and facilitates the exposure of the lower posterior mediastinum and distal esophagus, which are critical for the successful execution of the procedure.
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The esophagomyotomy (Heller type) procedure, coded as CPT® 43330, is indicated for the following conditions:
The procedure involves several critical steps to ensure effective treatment of esophageal achalasia:
After the esophagomyotomy procedure, patients typically require monitoring for any complications. Post-operative care may include the management of the nasogastric tube, which is used to decompress the stomach and prevent nausea. Patients can expect a recovery period during which they may gradually resume oral intake, starting with clear liquids and progressing as tolerated. It is essential to follow up with the healthcare provider to assess the success of the procedure and monitor for any potential complications, such as infection or esophageal perforation.
| Short Descr | ESOPHAGOMYOTOMY ABDOMINAL | Medium Descr | ESOPHAGOMYOTOMY HELLER TYPE ABDOMINAL APPROACH | Long Descr | Esophagomyotomy (Heller type); abdominal approach | 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.
| 43338 | Addon Code MPFS Status: Active Code APC C Esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (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). | 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. | 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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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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