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The CPT® Code 43425 refers to the surgical procedure for the closure of an esophagostomy or fistula using either a transthoracic or transabdominal approach. An esophagostomy is a surgical opening created in the esophagus, often necessitated by various medical conditions that affect the normal function of the esophagus. This procedure is typically performed when there is a need to close an existing esophagostomy or fistula, which may have been created for feeding or drainage purposes. The closure can be approached from two different anatomical regions: the thorax or the abdomen. In the transthoracic approach, the surgeon accesses the esophagus through the chest cavity, while in the transabdominal approach, the access is through the abdominal cavity. Each approach has specific techniques and considerations, which are crucial for the successful closure of the esophagostomy or fistula, ensuring that the esophagus is properly reconnected and that the surrounding tissues are adequately healed. This procedure is essential for restoring normal esophageal function and preventing complications associated with the presence of an esophagostomy or fistula.
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The closure of an esophagostomy or fistula using CPT® Code 43425 is indicated in several clinical scenarios, particularly when there is a need to restore normal esophageal continuity after a previous surgical intervention. The following conditions may warrant this procedure:
The procedure for the closure of an esophagostomy or fistula involves several critical steps, which can vary depending on whether a transthoracic or transabdominal approach is utilized. Each approach has its specific procedural details that ensure effective closure and healing.
Post-procedure care following the closure of an esophagostomy or fistula is critical for ensuring proper recovery and minimizing complications. Patients are typically monitored for any signs of infection or complications related to the surgical site. Nutritional support may be necessary, and patients may initially be placed on a modified diet to allow the esophagus to heal properly. Follow-up appointments are essential to assess the healing process and to ensure that the esophagus is functioning correctly. Any additional interventions or adjustments to the patient's care plan will be based on the recovery progress and any emerging needs.
| Short Descr | REPAIR ESOPHAGUS OPENING | Medium Descr | CLSR ESOPHAGOSTOMY/FSTL TTHRC/TABDL APPR | Long Descr | Closure of esophagostomy or fistula; transthoracic or transabdominal 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. | 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). | 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 | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | LT | Left side (used to identify procedures performed on the left side of the body) |
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| 2011-01-01 | Changed | Guideline information changed. |
| Pre-1990 | Added | Code added. |
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