2025 CPT code 43286
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Laparoscopic-assisted near-total or total esophagectomy with open cervical esophagogastrostomy or pharyngogastrostomy; with or without pyloric drainage procedure.
Modifiers may be applied depending on the circumstances (e.g., 58 for staged or related procedures).Consult the most current CPT guidelines for appropriate modifier usage.
Medical necessity for this procedure is established when a patient presents with esophageal cancer, severe esophageal injury requiring extensive resection, or spontaneous esophageal rupture requiring surgical repair. The decision to perform a laparoscopic-assisted versus a purely open approach should be based on clinical judgment, taking into account the patient’s overall condition and the extent of disease.
The surgeon is responsible for all aspects of the procedure, including pre-operative planning, intra-operative technique, and post-operative care.This may involve collaboration with other specialists such as anesthesiologists, gastroenterologists, and oncologists.
In simple words: The surgeon removes most or all of the esophagus and the top part of the stomach using small incisions and a camera.The stomach is then reattached to the throat using an incision in the neck.In some cases, the surgeon also widens the opening between the stomach and small intestine.
This procedure involves the laparoscopic removal of all or most of the esophagus and the upper part of the stomach.The surgeon mobilizes the remaining portion of the esophagus behind the mediastinum (if any) using laparoscopic access. An open cervical approach is then used to connect the stomach to the pharynx (pharyngogastrostomy) or to the remaining esophagus (esophagogastrostomy). A pyloric drainage procedure may or may not be performed during the laparoscopic phase.
Example 1: A 60-year-old male patient presents with esophageal cancer.A laparoscopic-assisted near-total esophagectomy with open cervical esophagogastrostomy is performed to remove the cancerous tumor., A 55-year-old female patient has suffered a severe esophageal injury due to ingestion of caustic substances.A total esophagectomy with pharyngogastrostomy is performed using laparoscopic assistance., A 70-year-old male patient experiences a spontaneous esophageal rupture. A laparoscopic-assisted near-total esophagectomy with open cervical esophagogastrostomy and pyloroplasty is performed for repair.
Complete medical history, including details of the patient’s symptoms and any prior medical conditions.Preoperative imaging studies (e.g., endoscopy, CT scan, MRI) to confirm the diagnosis and extent of disease.Operative report detailing the procedure performed, including type of esophagectomy, method of anastomosis, and any complications.Pathology report confirming the diagnosis and staging of the disease.Postoperative progress notes documenting the patient’s recovery and any complications.Imaging studies (e.g., chest x-ray) post-operation to assess for any leaks or complications.
** This code encompasses a range of procedures, from near-total to total esophagectomy, with variation in the use of pyloric drainage.Precise documentation is essential to ensure appropriate reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: Technical component modifiers may be applicable. Refer to the current CPT guidelines and NCCI edits for details.
- Specialties:General Surgery, Thoracic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center