2025 CPT code 43117
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Partial esophagectomy of the distal two-thirds of the esophagus, using thoracotomy and a separate abdominal incision. This may include removal of a portion of the upper stomach (proximal gastrectomy) and involves connecting the remaining esophagus to the stomach in the chest (thoracic esophagogastrostomy). It may also include widening the stomach outlet (pyloroplasty).
Modifiers may be applicable to this code to indicate specific circumstances of the procedure. For example, modifier -22 may be used for increased procedural services, and modifier -59 may be used to indicate a distinct procedural service.
Medical necessity should be established by pre-operative diagnostic findings that justify the partial esophagectomy, such as cancer, stricture, severe damage or spontaneous rupture of the esophagus. The documentation should demonstrate the severity of the condition and why a less invasive procedure is not appropriate.
The surgeon is responsible for performing the partial esophagectomy, which includes the incisions, dissection and removal of the affected part of the esophagus, possible removal of part of the stomach, reconstruction of the digestive tract by connecting the remaining esophagus to the stomach, and possible pyloroplasty. They are also responsible for postoperative care.
In simple words: This surgery removes the lower part of the esophagus, sometimes along with a part of the upper stomach. It involves two incisions, one in the chest and one in the abdomen. The surgeon then reconnects the remaining esophagus to the stomach. Sometimes, an additional procedure to widen the stomach opening is also performed.
Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal incision, with or without proximal gastrectomy; with thoracic esophagogastrostomy, with or without pyloroplasty (Ivor Lewis). This procedure involves the removal of the distal two-thirds of the esophagus, often due to cancer, severe damage, or spontaneous rupture. It requires incisions in both the chest (thoracotomy) and abdomen. The diseased portion of the esophagus is dissected and removed. A portion of the upper stomach may also be removed (proximal gastrectomy). The remaining stomach is then brought up into the chest and connected to the remaining esophagus (thoracic esophagogastrostomy).A pyloroplasty (widening the pyloric valve) may also be performed to improve the flow of food from the stomach into the small intestine.
Example 1: A patient with esophageal cancer located in the lower two-thirds of the esophagus undergoes a partial esophagectomy (43117) with proximal gastrectomy to remove the tumor and a margin of healthy tissue. The remaining esophagus and stomach are reconnected, and a pyloroplasty is performed., A patient who experienced severe damage to their distal esophagus from accidental ingestion of a corrosive substance requires a partial esophagectomy (43117). The damaged section is removed, and the remaining esophagus is connected to the stomach to restore digestive continuity. Pyloroplasty is also performed., A patient with a spontaneous rupture of the esophagus in the lower two-thirds undergoes a partial esophagectomy (43117) with thoracic esophagogastrostomy to repair the rupture and remove the damaged tissue. In this case, a proximal gastrectomy is not necessary.
Operative report detailing the procedure performed, including the extent of the esophagectomy, whether a proximal gastrectomy was performed, type of esophagogastrostomy, and if a pyloroplasty was performed. Diagnostic reports supporting the medical necessity of the procedure, such as imaging studies and pathology reports.
** This procedure is often referred to as the Ivor Lewis esophagectomy method.
- Revenue Code: P1G - Major Procedure - Other
- Specialties:Thoracic Surgery, General Surgery
- Place of Service:Inpatient Hospital