2025 CPT code 43288
(Active) Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Total or near-total esophagectomy with thoracoscopic mobilization of the esophagus, laparoscopic proximal gastrectomy, and open cervical esophagogastrostomy or pharyngogastrostomy.
Modifiers may be applicable. Refer to current CPT guidelines for appropriate modifier usage.
Medical necessity must be established by documenting the underlying condition requiring esophagectomy (e.g., cancer, severe stricture, rupture).The chosen surgical approach should be justified based on the patient's condition and the surgeon's expertise. Payer-specific medical necessity guidelines must be followed.
The physician performs the esophagectomy, including mobilization of the esophagus, gastrectomy, pyloric drainage (if performed), and the final anastomosis.They are responsible for the patient's pre- and post-operative care, managing any complications, and ensuring proper documentation.
In simple words: This is a complex surgery to remove most or all of the esophagus (the food pipe). It involves small incisions in the chest and abdomen with tiny cameras and instruments. Part of the stomach is also removed, and the remaining stomach is then connected to the throat or what's left of the esophagus through an incision in the neck.
This procedure involves the removal of all or almost all of the esophagus. The surgeon uses a thoracoscopic approach to mobilize the esophagus in the upper, middle, and lower mediastinum. A separate laparoscopic proximal gastrectomy (removal of the upper part of the stomach) is performed, along with a laparoscopic pyloric drainage procedure (if necessary). Finally, an open cervical approach is used to create a connection between the stomach and either the pharynx (pharyngogastrostomy) or the remaining part of the esophagus (esophagogastrostomy).
Example 1: A patient with advanced esophageal cancer requires a near-total esophagectomy. The surgeon performs the procedure using a combined thoracoscopic, laparoscopic, and cervical approach (McKeown esophagectomy)., A patient with severe damage to the esophagus from caustic ingestion necessitates a total esophagectomy.A pyloric drainage procedure is also performed to facilitate gastric emptying., A patient with a spontaneous esophageal rupture requires emergency esophagectomy. Due to the patient's condition, a minimally invasive approach is chosen, combining thoracoscopic and laparoscopic techniques with an open cervical anastomosis.
Operative report detailing the extent of esophagectomy, type of approach (thoracoscopic, laparoscopic, cervical), whether a pyloric drainage procedure was performed, and any complications. Pathology report confirming diagnosis and margins. Pre- and post-operative notes documenting the medical necessity of the procedure and the patient's progress.
- Revenue Code: P1G - MAJOR PROCEDURE - OTHER
- Specialties:Thoracic Surgery, General Surgery
- Place of Service:Inpatient Hospital