2025 CPT code 43361
Effective Date: N/A Surgery - Surgical Procedures on the Digestive System Feed
Gastrointestinal reconstruction for previous esophagectomy, for obstructing esophageal lesion or fistula, or for previous esophageal exclusion; with colon interposition or small intestine reconstruction.
Modifiers may be applicable depending on the circumstances.For example, modifier 22 (Increased Procedural Services) may be used if the procedure was significantly more complex than usual. Modifier 59 (Distinct Procedural Service) may be used to indicate that the procedure was separate from other services performed on the same day.It's crucial to check payer-specific guidelines for modifier usage.
Medical necessity must be established by documenting the patient’s symptoms, such as dysphagia (difficulty swallowing), pain, regurgitation, or weight loss, and demonstrating how these symptoms are related to the previous esophagectomy or a complication like fistula formation. Documentation should also show that less invasive treatment options have been considered or tried unsuccessfully.
The surgeon performs the procedure after prepping and anesthetizing the patient. Incisions are made in the chest and/or abdomen to access the surgical area.The surgeon examines the remaining esophagus and identifies the obstruction or disease site. Obstructing tissue is removed, narrowed areas are widened, and the esophagus is repaired. If a graft is needed, a section of colon or small bowel is harvested, and the ends are reconnected.The graft is then connected to the remaining esophagus and stomach. The surgeon ensures bleeding is controlled, removes instruments, and closes the incisions.
In simple words: This procedure is a corrective surgery performed after the esophagus has been removed.It's done to fix problems like blockages, abnormal connections, or bypasses in the digestive system. The surgeon may use part of the colon or small intestine to rebuild the connection and allow food to pass through properly.
This procedure involves reconstructing the gastrointestinal tract after a prior esophagectomy (removal of the esophagus). It addresses complications like esophageal lesions, fistulas (abnormal connections), or previous esophageal exclusion. The reconstruction may involve using a segment of the colon (colon interposition) or small intestine, including the necessary mobilization, preparation, and creation of surgical connections (anastomoses).
Example 1: A patient experiences difficulty swallowing due to a stricture (narrowing) that formed after an esophagectomy. The surgeon performs CPT code 43361, using a segment of the colon to reconstruct the esophagus and restore normal swallowing function., A patient develops a fistula (abnormal connection) between the remaining esophagus and the trachea after esophageal cancer surgery. The surgeon performs 43361 to repair the fistula and reconstruct the esophagus using a portion of the small intestine., Following a previous esophageal exclusion procedure, a patient experiences recurrent reflux. The surgeon performs 43361 to reconstruct the gastrointestinal tract, using a colon interposition to create a new esophageal pathway and alleviate the reflux.
Operative report detailing the reason for the revision surgery, the methods used for reconstruction, the segments of bowel utilized (if any), and any complications encountered. Any imaging or endoscopic findings that support the need for the procedure.
- Specialties:Thoracic Surgery, General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center