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The procedure described by CPT® Code 43331 is known as esophagomyotomy (Heller type) performed via a thoracic 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 thoracic approach, typically involving a right posterior thoracotomy, allows for direct access to the esophagus. During the procedure, an incision is made through the skin and extended through the underlying soft tissues, with careful retraction of the scapula to enter the thoracic cavity without damaging the pleura. This approach facilitates retropleural dissection, enabling the surgeon to expose the distal esophagus effectively. The procedure involves making a longitudinal incision in the muscular wall of the distal esophagus, which is then extended down to the gastric cardia, severing all muscle fibers down to the submucosal layer of both the esophagus and stomach. Postoperatively, a nasogastric tube is typically placed to assist with gastric decompression, and if a thoracic approach is utilized, a chest tube may also be inserted to manage any potential pleural effusion. The incisions, whether abdominal or thoracic, are subsequently closed in layers to promote optimal healing.
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The esophagomyotomy (Heller type) procedure, coded as CPT® 43331, is indicated for the following conditions:
The procedure involves several critical steps to ensure effective treatment of esophageal achalasia:
Post-procedure care for patients undergoing esophagomyotomy (Heller type) includes monitoring for any complications related to the thoracic approach, such as pleural effusion or infection. Patients are typically observed for signs of respiratory distress, and the nasogastric tube is maintained for gastric decompression until the patient can tolerate oral intake. The recovery process may involve pain management and gradual reintroduction of diet, starting with clear liquids and progressing as tolerated. Follow-up appointments are essential to assess the surgical site and ensure proper healing.
| Short Descr | ESOPHAGOMYOTOMY THORACIC | Medium Descr | ESOPHAGOMYOTOMY HELLER TYPE THORACIC APPROACH | Long Descr | Esophagomyotomy (Heller type); thoracic 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) |
| 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). | 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). | 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 | RT | Right side (used to identify procedures performed on the right side of the body) |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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