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The CPT® Code 43420 refers to the surgical procedure for the closure of an esophagostomy or fistula through a cervical approach. This procedure is specifically indicated when the site of the esophagostomy or fistula is located in the cervical esophagus, which is the portion of the esophagus situated in the neck region. The surgical intervention involves making an incision in the neck, strategically positioned anterior to the sternocleidomastoid muscle. This incision is made between the thyroid gland and the trachea medially, while the carotid sheath is located laterally. During the procedure, critical structures such as the internal jugular vein and carotid artery are identified and carefully retracted laterally to provide adequate access to the esophagus. The closure of the esophagostomy or fistula is essential for restoring normal esophageal function and preventing complications associated with the presence of an abnormal opening in the esophagus. This procedure is distinct from similar procedures that may involve thoracic or abdominal approaches, which are addressed under different CPT® codes. The cervical approach is specifically tailored to address issues arising in the upper segment of the esophagus, ensuring that the surgical technique is appropriate for the anatomical location of the esophagostomy or fistula.
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The closure of an esophagostomy or fistula via a cervical approach, as described by CPT® Code 43420, is indicated for specific conditions related to the cervical esophagus. These indications may include:
The procedure for the closure of an esophagostomy or fistula through a cervical approach involves several critical steps, which are detailed as follows:
Post-procedure care following the closure of an esophagostomy or fistula via a cervical approach is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or leakage at the closure site. Nutritional support may be required, often starting with a modified diet to allow the esophagus to heal properly. Follow-up appointments are necessary to assess the healing process and ensure that the esophagus is functioning correctly. Additionally, patients may need to be educated on signs of complications that should prompt immediate medical attention, such as difficulty swallowing, persistent pain, or fever.
| Short Descr | REPAIR ESOPHAGUS OPENING | Medium Descr | CLSR ESOPHAGOSTOMY/FSTL CRV APPR | Long Descr | Closure of esophagostomy or fistula; 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) | 0 - Payment restriction for assistants at surgery applies 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 | Hospital Part B services paid through a comprehensive APC | 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 |
| 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.) | 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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| Pre-1990 | Added | Code added. |
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