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Esophagostomy, specifically the procedure described by CPT® Code 43352, involves the surgical creation of a fistula in the esophagus through a cervical approach. This procedure is primarily performed to facilitate normal eating for patients who may have obstructions or other conditions affecting the esophagus. During the operation, the upper portion of the esophagus is brought to the surface of the skin, creating a stoma, while the lower portion is surgically closed. This stoma allows for the insertion of an esophageal tube, which is designed to assist with feeding. The tube features a flange that is positioned within the esophagus and lies completely beneath the skin, with part of it extending outside the body. This external portion is then connected to a gastrostomy tube, enabling nutritional intake. The procedure is distinct from similar interventions, such as CPT® Code 43351, which involves the thoracic esophagus and requires a different surgical approach. In the case of CPT® Code 43352, careful attention is given to the anatomy of the neck, particularly the protection of critical structures such as the recurrent laryngeal nerves during the mobilization of the esophagus. The successful completion of this procedure allows for the management of esophageal conditions while providing a means for the patient to maintain nutritional intake.
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Esophagostomy, specifically the procedure described by CPT® Code 43352, is indicated for patients who require an alternative means of nutrition due to various esophageal conditions. The following are the explicit indications for performing this procedure:
The procedure for esophagostomy via the cervical approach, as described by CPT® Code 43352, involves several critical steps:
After the esophagostomy procedure, patients typically require careful monitoring and post-operative care. 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. This tube is designed to facilitate feeding while ensuring that the flange remains positioned within the esophagus and beneath the skin. Patients may need to follow specific dietary guidelines and may require assistance with tube management to ensure proper nutrition and prevent complications. Regular follow-up appointments are essential to monitor the healing process and the functionality of the stoma.
| Short Descr | SURGICAL OPENING ESOPHAGUS | Medium Descr | ESOPHAGOSTOMY FSTLJ ESOPH XTRNL CRV APPR | Long Descr | Esophagostomy, fistulization of esophagus, external; cervical 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 |
| 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. | 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.) | 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). | 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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