© Copyright 2025 American Medical Association. All rights reserved.
The esophageal lengthening procedure, as described by CPT® Code 43338, refers to surgical techniques such as Collis gastroplasty or wedge gastroplasty that are performed to extend the length of the esophagus. This procedure is typically indicated during a separate open surgical intervention for a hiatal hernia. The primary goal of the esophageal lengthening is to facilitate the proper alignment and function of the esophagus in relation to the stomach, particularly when addressing complications associated with gastroesophageal reflux disease (GERD) or other anatomical abnormalities. During the procedure, careful dissection is performed to remove the gastroesophageal fat pad while preserving the vagal nerves, which are crucial for maintaining gastrointestinal motility and function. The use of a dilator, or bougie, is essential for guiding the surgical instruments and ensuring the correct positioning of the esophagus and stomach. The procedure culminates in the creation of a neoesophagus, which is a newly formed segment of the esophagus, and a new angle of His, which is the angle formed between the esophagus and the stomach. This surgical intervention is performed in conjunction with a primary procedure, often involving fundoplication, to secure the esophagus and prevent reflux, thereby enhancing the overall effectiveness of the surgical treatment for hiatal hernia and related conditions.
© Copyright 2025 Coding Ahead. All rights reserved.
The esophageal lengthening procedure (CPT® Code 43338) is indicated for specific conditions that necessitate the extension of the esophagus during surgical interventions. The following are the explicitly provided indications for this procedure:
The esophageal lengthening procedure involves several critical steps that are performed with precision to ensure optimal outcomes. The following procedural steps are outlined:
After the esophageal lengthening procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper recovery of gastrointestinal function. Patients may be advised on dietary modifications and gradual reintroduction of oral intake as they heal. Follow-up appointments are essential to assess the success of the procedure and to monitor for any potential complications, such as reflux or dysphagia. The overall recovery period may vary depending on the individual patient's health status and the complexity of the surgical intervention performed.
| Short Descr | ESOPH LENGTHENING | Medium Descr | ESOPHAGUS LENGTHENING | Long Descr | Esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 an add-on code that must be used in conjunction with one of these primary codes.
| 43280 | MPFS Status: Active Code APC J1 Physician Quality Reporting CPT Assistant Article Illustration for Code Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures) | 43327 | MPFS Status: Active Code APC C Esophagogastric fundoplasty partial or complete; laparotomy | 43328 | MPFS Status: Active Code APC C Esophagogastric fundoplasty partial or complete; thoracotomy | 43330 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Esophagomyotomy (Heller type); abdominal approach | 43331 | MPFS Status: Active Code APC C Physician Quality Reporting Illustration for Code Esophagomyotomy (Heller type); thoracic approach | 43332 | MPFS Status: Active Code APC C Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; without implantation of mesh or other prosthesis | 43333 | MPFS Status: Active Code APC C Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis | 43334 | MPFS Status: Active Code APC C Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; without implantation of mesh or other prosthesis | 43335 | MPFS Status: Active Code APC C Repair, paraesophageal hiatal hernia (including fundoplication), via thoracotomy, except neonatal; with implantation of mesh or other prosthesis | 43336 | MPFS Status: Active Code APC C Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis | 43337 | MPFS Status: Active Code APC C Repair, paraesophageal hiatal hernia, (including fundoplication), via thoracoabdominal incision, except neonatal; with implantation of mesh or other prosthesis |
| 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. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 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. | 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). | 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 |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Added | Added |
Get instant expert-level medical coding assistance.