2025 CPT code 43510
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Gastrotomy with esophageal dilation and insertion of a permanent intraluminal tube.
Modifiers may be necessary depending on the circumstances of the procedure. For example, modifier -51 (Multiple Procedures) may be applicable if other procedures are performed during the same surgical session.
The procedure is medically necessary when conservative management (e.g., endoscopic dilation) fails to provide adequate relief of dysphagia in patients with esophageal strictures.Medical necessity requires documentation supporting the severity of the stricture, its impact on the patient's nutritional status and quality of life, and the failure of less invasive treatment options.
The surgeon is responsible for performing the gastrotomy, dilating the esophageal stricture, and inserting the permanent intraluminal tube. An anesthesiologist will be involved in providing anesthesia, and other members of the surgical team (e.g., surgical assistants, nurses) contribute to the procedure's success.
In simple words: The doctor makes a small cut in the stomach, then widens a narrowed part of the esophagus (the food pipe) and inserts a small, permanent tube to help with swallowing. This is usually done to relieve symptoms of a narrowed esophagus caused by cancer or radiation treatment.
This CPT code describes a surgical procedure involving a gastrotomy (incision into the stomach), followed by dilation of an esophageal stricture (narrowing), and the placement of a permanent intraluminal tube (such as an Atkinson tube) into the esophagus.The procedure is typically performed for palliative treatment of esophageal strictures caused by cancerous overgrowth or scarring from radiation therapy. The surgeon makes an incision in the abdomen or, if the abdomen is already open, a small incision in the stomach. Bougies may be used to dilate the stricture from below through the gastrotomy. The Atkinson tube is then passed through the stricture, excess tube is cut, and the gastrotomy is closed.Bleeding is checked, instruments are removed, and the abdominal incision is closed.
Example 1: A 65-year-old male patient with a history of esophageal cancer experiences progressive dysphagia (difficulty swallowing).A gastrotomy with esophageal dilation and placement of an Atkinson tube is performed to improve swallowing function and allow for better nutritional intake., A 70-year-old female patient develops esophageal stricture secondary to radiation therapy for a previous lung cancer.A gastrotomy with esophageal dilation and insertion of a Celestin tube is performed to alleviate dysphagia and improve quality of life. , A 58-year-old male patient presents with severe esophageal stricture, unresponsive to prior endoscopic dilation attempts. Surgical intervention is deemed necessary; a gastrotomy is performed to facilitate placement of a permanent intraluminal stent.
* Preoperative evaluation and assessment of the patient's esophageal stricture (e.g., endoscopy findings, radiology reports).* Detailed operative notes describing the gastrotomy, dilation technique, type of intraluminal tube used, and any intraoperative complications.* Postoperative progress notes detailing recovery and any complications.* Pathology reports (if a biopsy was performed).
** The choice of intraluminal tube (Atkinson, Celestin, or Mousseaux-Barbin) should be documented.This procedure is relatively uncommon due to advancements in endoscopic management of esophageal strictures.Careful review of medical records is crucial to accurately apply this code.
- Revenue Code: Check payer-specific guidelines for appropriate revenue codes.
- RVU: Refer to the CMS relative value units database for the most up-to-date information on RVUs and associated payment rates.These values vary by geographic location and other factors.
- Global Days: The global surgical period for this procedure will vary based on payer-specific guidelines; usually, it includes the pre-operative and post-operative care provided by the surgeon.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule information is not available in the given source.
- Specialties:Gastroenterology, Surgical Oncology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center