© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 43496 refers to a surgical procedure known as a free jejunum transfer with microvascular anastomosis. This procedure is commonly described as a free jejunal graft or flap. It involves the surgical harvesting of a segment of the jejunum, which is a part of the small intestine, to be used for reconstruction or repair in another area of the body. The process begins with an incision in the abdomen to access the jejunum. The surgeon carefully exposes the jejunum and identifies the specific segment that will be harvested. It is crucial to mark the distal end of the graft segment to ensure that it is oriented correctly, allowing for normal peristalsis, which is the wave-like muscle contractions that move food through the digestive tract. During the procedure, the artery that supplies blood to the segment of jejunum being harvested is located, and the associated blood vessels are meticulously dissected back to their branching points. These vessels are then suture ligated and divided to prepare the graft for removal. The jejunum is subsequently divided, and the graft segment is excised along with its supplying blood vessels. To maintain continuity of the small bowel, the remaining distal and proximal segments of the jejunum are anastomosed, or surgically connected. Once the graft segment is removed, it is transferred to the designated site where it will be placed. This transfer site is prepared as part of a separately reportable procedure. The orientation of the jejunal graft is critical, and the surgeon ensures that the marked distal end is correctly positioned. The serosal layer of the jejunum is then secured to the surrounding tissue to relieve tension on the anastomosis sites. Finally, the proximal and distal ends of the graft are anastomosed to the remaining esophageal or bowel segments, followed by the performance of microvascular anastomosis, which involves connecting the jejunal blood vessels to the vessels at the anastomosis site to restore blood flow.
© Copyright 2025 Coding Ahead. All rights reserved.
The free jejunum transfer with microvascular anastomosis is indicated for various surgical scenarios where reconstruction or repair of the gastrointestinal tract is necessary. The following conditions may warrant this procedure:
The procedure for free jejunum transfer with microvascular anastomosis involves several critical steps, each essential for the successful completion of the surgery. The following outlines the procedural steps:
After the completion of the free jejunum transfer with microvascular anastomosis, post-procedure care is essential for optimal recovery. Patients are typically monitored for any signs of complications, such as infection or graft failure. The recovery process may involve a hospital stay where the surgical site is observed, and the patient's overall condition is assessed. Nutritional support may be necessary, especially if the patient has difficulty resuming normal eating patterns. Follow-up appointments are crucial to evaluate the success of the graft and to ensure that the anastomosis sites are healing properly. Additional interventions may be required based on the patient's recovery progress and any complications that may arise.
| Short Descr | FREE JEJUNUM FLAP MICROVASC | Medium Descr | FREE JEJUNUM TRSF W/MICROVASC ANASTOMOSIS | Long Descr | Free jejunum transfer with microvascular anastomosis | Status Code | Carriers Price the 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 | 75 - Small bowel resection |
| 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. | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2011-01-01 | Changed | Short description changed. |
| 1997-01-01 | Added | First appearance in code book in 1997. |
Get instant expert-level medical coding assistance.