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The procedure described by CPT® Code 43405 involves the surgical intervention at the gastroesophageal junction, specifically targeting a pre-existing esophageal perforation. This condition typically arises when there is a tear or hole in the esophagus, which can lead to serious complications such as infection or leakage of esophageal contents into the surrounding areas. The surgical approach begins with a right posterolateral thoracotomy, which is a surgical incision made in the chest to access the esophagus. The skin is carefully incised, and the incision is extended through the underlying soft tissues to provide adequate exposure. During this process, the scapula is retracted to facilitate entry into the thoracic cavity without damaging the pleura, the membrane surrounding the lungs. Once inside the thorax, a retropleural dissection is performed, allowing the lung to be retracted and the perforation at the gastroesophageal junction to be clearly visualized. Alternatively, a transhiatal abdominal approach may be employed, which involves accessing the esophagus through the abdominal cavity. This method also requires careful dissection of the esophagus and stomach from surrounding tissues to enable thorough inspection and repair of the defect. Any ragged or necrotic tissue present around the perforation is meticulously debrided to promote healing and prevent infection. The final step of the procedure involves repairing the perforation through ligation or stapling, effectively closing the defect and restoring the integrity of the esophagus. After the repair, the thoracic or abdominal incision is closed, completing the surgical intervention.
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The procedure associated with CPT® Code 43405 is indicated for patients presenting with a pre-existing esophageal perforation. This condition may arise due to various factors, including trauma, malignancy, or complications from other medical procedures. The following are specific indications for performing this surgical intervention:
The surgical procedure for CPT® Code 43405 involves several critical steps to ensure effective repair of the esophageal perforation. The following outlines the procedural steps:
After the completion of the procedure, patients typically require monitoring for any signs of complications, such as infection or leakage at the repair site. Post-operative care may include pain management, nutritional support, and gradual reintroduction of oral intake as tolerated. The healthcare team will also monitor the patient's respiratory status, especially if a thoracotomy was performed, to ensure proper lung function and prevent complications such as pneumonia. Follow-up appointments are essential to assess the healing process and to ensure that the esophagus is functioning properly after the repair.
| Short Descr | LIGATE/STAPLE ESOPHAGUS | Medium Descr | LIG/STAPLING G-ESOP JUNCT PRE-ESOPHGL PRF8J | Long Descr | Ligation or stapling at gastroesophageal junction for pre-existing esophageal perforation | 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). | 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. | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 1995-01-01 | Added | First appearance in code book in 1995. |
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