2025 CPT code 43113
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Total or near total esophagectomy, with thoracotomy; with colon interposition or small intestine reconstruction, including intestine mobilization, preparation, and anastomosis(es).
Modifiers may be applicable to 43113.Refer to current CPT guidelines for appropriate use.
Medical necessity for 43113 is established by conditions such as esophageal cancer, severe esophageal damage (e.g., caustic ingestion), or spontaneous esophageal rupture. Documentation supporting the diagnosis and the need for surgical intervention is essential for justifying the medical necessity of this procedure.
The surgeon performs the esophagectomy, which involves opening the chest (thoracotomy), neck and abdomen. The esophagus is divided and separated. If any healthy portion remains, division occurs in the neck; otherwise, at the pharynx. A segment of colon or small bowel is freed, preserving its blood supply. This segment is used as a graft. The intestine is reconnected, and the graft is positioned in the chest and connected to the remaining esophagus or pharynx and stomach. Leak tests and wound closure complete the procedure.
In simple words: The surgeon removes most or all of the esophagus (the food pipe) through incisions in the chest, neck, and abdomen.A section of the colon or small intestine is used to create a new esophagus. The surgeon carefully detaches this section, preserving its blood supply, and connects it to the remaining part of the esophagus or pharynx at one end and the stomach at the other.
This procedure involves the removal of all or almost all of the esophagus. It includes an incision in the chest (thoracotomy), and the esophagus is reconstructed using either a segment of the colon (colon interposition) or small intestine. The procedure encompasses the necessary steps of mobilizing and preparing the bowel segment used for reconstruction and creating the connections (anastomoses) between the remaining esophagus, the graft, and the stomach.
Example 1: A patient with advanced esophageal cancer undergoes a total esophagectomy using a section of their colon to rebuild the esophagus., A patient with severe damage to their esophagus from accidentally swallowing a corrosive substance requires a near-total esophagectomy with small bowel reconstruction., A patient with a spontaneous rupture of the esophagus undergoes an esophagectomy with colon interposition.
Documentation should include operative reports detailing the extent of the esophagectomy (total or near-total), the type of reconstruction (colon interposition or small bowel), the thoracotomy approach, the bowel mobilization and preparation, and the anastomoses performed. Any complications encountered should also be documented. Preoperative imaging and pathology reports confirming the diagnosis necessitating the esophagectomy are crucial.
- Revenue Code: P1G
- Specialties:Thoracic Surgery, General Surgery, Surgical Oncology
- Place of Service:Inpatient Hospital