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Total or partial esophagectomy, without reconstruction, with cervical esophagostomy is a surgical procedure that involves the removal of a portion or the entirety of the esophagus, which is the tube that carries food from the throat to the stomach. This procedure can be performed using various approaches, including cervical, thoracic, or abdominal (transhiatal) methods. In the cervical approach, an incision is made in the neck, typically on the left side, allowing access to the esophagus. The internal jugular vein and carotid artery are carefully identified and retracted to expose the esophagus for surgical intervention. In contrast, the thoracic approach generally involves a right posterior thoracotomy, where an incision is made in the skin and extended through the soft tissues to access the thoracic cavity without disrupting the pleura. This method allows for retropleural dissection and retraction of the lung to expose the esophagus. The abdominal approach requires an incision in the upper abdomen to explore the peritoneal cavity, mobilizing the stomach at the gastroesophageal junction and splitting the diaphragmatic hiatus to access the lower posterior mediastinum and esophagus. Once the esophagus is adequately exposed, the diseased segment is removed, and the proximal and distal stumps are repaired. A cervical esophagostomy is then created, which involves making an incision in the neck if it has not been previously accessed during the esophagectomy. This esophagostomy allows for the placement of a feeding tube, which is essential for nutrition post-surgery. The feeding tube is passed through a tunnel created during the esophagectomy to the distal esophageal stump, where a longitudinal incision is made in the wall of the remaining distal esophageal segment. The feeding tube is then inserted through this incision and into the stomach, and the incision is secured around the feeding tube with a purse-string suture. Finally, the incision in the neck is also closed around the feeding tube, completing the procedure. This complex surgical intervention is typically indicated for patients with esophageal malignancies or other significant lesions affecting the esophagus.
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The total or partial esophagectomy, without reconstruction, with cervical esophagostomy is indicated for various conditions affecting the esophagus. These may include:
The procedure for total or partial esophagectomy, without reconstruction, with cervical esophagostomy involves several critical steps, which are detailed as follows:
Post-procedure care following a total or partial esophagectomy with cervical esophagostomy involves monitoring the patient for complications and ensuring proper recovery. Patients may require nutritional support through the feeding tube until they can resume oral intake. Regular assessments of the surgical site for signs of infection or complications are essential. Additionally, patients may need to follow specific dietary guidelines and engage in rehabilitation to aid recovery and adapt to changes in swallowing function. Follow-up appointments are crucial to evaluate healing and address any concerns that may arise during the recovery process.
| Short Descr | REMOVAL OF ESOPHAGUS | Medium Descr | TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY | Long Descr | Total or partial esophagectomy, without reconstruction (any approach), with cervical esophagostomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 94 - Other OR upper GI therapeutic procedures |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 1995-01-01 | Added | First appearance in code book in 1995. |
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