2025 CPT code 43123
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Partial esophagectomy, using a thoracoabdominal or abdominal approach, with or without partial stomach removal; involves colon or small bowel interposition, including bowel mobilization, preparation, and anastomosis.
Modifiers may be applicable depending on the specific circumstances of the case.For example, modifier 22 (increased procedural services) or 59 (distinct procedural service) may be used if additional significant work was performed.
Medical necessity for this procedure is established when a patient presents with an esophageal condition requiring resection and reconstruction that meets established criteria, including the presence of cancer, severe trauma or injury, or a life-threatening condition.The procedure must be medically appropriate and consistent with accepted standards of care.
The clinical responsibility rests with the surgeon performing the esophagectomy and bowel interposition. This includes pre-operative assessment and planning, intraoperative surgical technique, and post-operative monitoring of the patient.Anesthesiology and pathology services are also integral parts of the patient care, as well as nursing and support staff.
In simple words: The surgeon removes a damaged part of the food pipe (esophagus) and possibly a small part of the stomach. A section of the large or small intestine is then used to replace the removed part of the esophagus and reconnect the digestive system.
This CPT code 43123 represents a surgical procedure involving the partial removal of the esophagus, possibly including a portion of the proximal stomach, accessed through either a thoracoabdominal or abdominal incision.The resected esophageal segment is replaced with a segment of colon or small bowel. This replacement involves meticulous mobilization and preparation of the intestinal segment, ensuring preservation of its blood supply.The procedure culminates in the creation of anastomoses (connections) to restore the continuity of the digestive tract, connecting the remaining esophagus and stomach to the intestinal graft. Post-operative leak detection checks may be performed using air or dye.This surgery addresses conditions like esophageal cancer, caustic injury, or spontaneous esophageal rupture.
Example 1: A 60-year-old male patient presents with esophageal cancer.A partial esophagectomy with colon interposition is performed to remove the cancerous tissue and restore esophageal continuity., A 35-year-old female patient suffered a severe caustic esophageal injury from accidental ingestion of a corrosive substance.Partial esophagectomy with small bowel interposition is performed to reconstruct the damaged esophagus., A 72-year-old patient presents with a spontaneous esophageal rupture.The surgeon performs a partial esophagectomy and reconstructs the esophagus using a colon segment, as well as addresses the underlying cause of the rupture.
Preoperative:Detailed patient history including symptoms, risk factors, and imaging studies (e.g., endoscopy, CT scan).Intraoperative:Surgical notes documenting the extent of the resection, the type of bowel graft used, the techniques of mobilization, preparation, and anastomosis, and intraoperative findings.Pathology reports detailing the resected tissue.Postoperative:Postoperative progress notes, imaging studies (e.g., chest x-ray, contrast studies) to assess for leaks.
** Thorough documentation is crucial for appropriate reimbursement.Coding should reflect the specific techniques and complexity of the procedure.Always refer to the most recent CPT coding guidelines and payer-specific requirements for accurate billing.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The RVUs for this procedure will vary based on geographic location, facility type, and other factors.Consult the CMS national physician fee schedule or your specific payer's fee schedule for current values.
- Global Days: The global surgical period for this procedure will depend on the specific circumstances of the case and the surgeon's practice, but typically includes the pre-operative, operative, and post-operative care.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a complete surgical procedure that may require assistance but does not break down into a technical and professional component.
- Fee Schedule: Historical fee schedule data is not provided here. This information varies by payer, location, and time period.Consult relevant fee schedules for specific historical data.
- Specialties:Thoracic Surgery, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center