2025 CPT code 43360
(Active) Effective Date: N/A Revision Date: N/A Surgery - Esophageal Procedures Digestive System Feed
Gastrointestinal reconstruction following a prior esophagectomy, addressing esophageal obstruction, fistula, or prior exclusion; utilizing stomach, with or without pyloroplasty.
Modifiers may be applicable depending on the specifics of the procedure performed. Refer to the CPT manual for guidance on modifier usage.
Medical necessity is established when there is an obstructing esophageal lesion, fistula, or prior esophageal exclusion requiring reconstruction to restore normal gastrointestinal function. Documentation must support the need for reconstruction based on the patient's clinical presentation and history.
The surgeon is responsible for pre-operative assessment and planning, performing the esophagectomy and reconstruction, ensuring hemostasis, and closing incisions. Anesthesiologists provide anesthesia and perioperative care. Other medical professionals may assist in various aspects of the procedure.
In simple words: This surgery repairs the food pipe (esophagus) and other parts of the digestive system after a previous surgery to remove part of the esophagus. It fixes problems like blockages or abnormal connections, using the stomach to rebuild the food pipe. The stomach might be widened to make it easier to swallow.
This procedure involves the reconstruction of the gastrointestinal tract after a previous esophagectomy.The reconstruction addresses an obstructing esophageal lesion, fistula, or prior esophageal exclusion. The procedure uses the stomach for reconstruction, potentially including pyloroplasty (widening of the pylorus) to facilitate food passage. The surgeon will remove the problem area, perform dilation, or repair the esophagus. The stomach is moved into the chest and attached to the esophageal stump. Hemostasis is ensured, and abdominal and chest incisions are closed in layers.
Example 1: A patient presents with an obstructing esophageal lesion following a previous esophagectomy. The surgeon performs a reconstruction using the stomach, including pyloroplasty to improve food passage., A patient develops an esophageal fistula after an esophagectomy. The surgeon reconstructs the esophagus using the patient's stomach, addressing the fistula and restoring esophageal integrity., A patient undergoes an esophagectomy for cancer, and the surgeon performs a gastric pull-up reconstruction with pyloroplasty to allow for a more normal esophageal function after tumor removal.
Preoperative assessment, including imaging studies (e.g., endoscopy, CT scan), pathology reports (if applicable), operative report detailing the procedure performed, postoperative recovery notes, pathology reports on resected tissue, and any complications encountered.
** Always ensure accurate documentation to support the medical necessity and the specific services rendered.Refer to payer-specific guidelines for any regional or local variations in coverage and reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: The relative value units (RVUs) for this code will vary based on geographic location, facility type (non-facility vs. facility), and other payer-specific factors. Consult the relevant fee schedule for accurate RVU and payment information.
- Global Days: The global surgical period for this procedure will depend on the complexity of the surgery and the specific circumstances of the patient and must be determined based on local guidelines and payer policies.
- Payment Status: Active
- Modifier TC rule: The applicability of a Technical Component (TC) modifier depends on the specific circumstances and billing practices of the provider.Consult local guidelines.
- Fee Schedule: Historical fee schedule data is unavailable from the provided source. Consult payer-specific fee schedules and databases for information on past reimbursement rates.
- Specialties:General Surgery, Thoracic Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center