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Esophagostomy, specifically the procedure described by CPT® Code 43351, involves the surgical creation of a fistula in the esophagus through a thoracic approach. This procedure is primarily performed to facilitate normal eating in patients who may have conditions that obstruct the esophagus or impair its function. The technique entails exteriorizing the proximal (upper) segment of the esophagus, which is brought out through the chest wall to form a stoma, while the distal (lower) segment is surgically closed. This stoma allows for the passage of food and fluids directly into the esophagus, bypassing any obstructions. Following the creation of the stoma, a healing period of approximately two weeks is observed, after which an esophageal tube with a flange is inserted. This tube is designed to remain partially outside the body, connecting to a gastrostomy tube for nutritional support. The thoracic approach typically involves a right posterior thoracotomy, where an incision is made in the skin and extended through the underlying soft tissues to access the thoracic cavity. Care is taken to avoid disrupting the pleura during the procedure, ensuring that the lung is retracted to expose the esophagus adequately for mobilization and division. The surgical technique emphasizes the importance of proper suturing to secure the esophagus to the skin, ensuring that the stoma remains functional for the patient’s nutritional needs.
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The procedure described by CPT® Code 43351 is indicated for patients who require a surgical intervention to facilitate normal eating due to various esophageal conditions. The following are specific indications for performing an esophagostomy via a thoracic approach:
The procedure for CPT® Code 43351 involves several critical steps to successfully create an esophagostomy through a thoracic approach:
After the esophagostomy procedure, patients typically undergo a recovery period that may involve monitoring for complications such as infection or leakage at the stoma site. The stoma is allowed to heal for approximately two weeks before any further interventions, such as the insertion of an esophageal tube with a flange, are performed. During this time, healthcare providers will assess the healing process and ensure that the patient is stable. Once the esophageal tube is in place, it is crucial to provide education on care for the stoma and the tube, including how to maintain hygiene and monitor for any signs of complications. Follow-up appointments will be necessary to evaluate the function of the stoma and the overall health of the patient.
| Short Descr | SURGICAL OPENING ESOPHAGUS | Medium Descr | ESOPHAGOSTOMY FSTLJ ESOPH XTRNL THRC APPR | Long Descr | Esophagostomy, fistulization of esophagus, external; 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.
| 32674 | Add-on Code MPFS Status: Active Code APC C Thoracoscopy, surgical; with mediastinal and regional lymphadenectomy (List separately in addition to code for primary procedure) | 38746 | Addon Code MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Thoracic lymphadenectomy by thoracotomy, mediastinal and regional lymphadenectomy (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). | 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.) | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| Pre-1990 | Added | Code added. |
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