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Esophagoplasty is a surgical procedure that involves the plastic repair or reconstruction of the esophagus, which is the muscular tube that connects the throat to the stomach. This procedure is typically indicated for various conditions that may compromise the integrity or function of the esophagus, such as blunt trauma, avulsion injuries, or the presence of a tracheoesophageal fistula, which is an abnormal connection between the trachea and the esophagus. The thoracic approach to esophagoplasty generally involves a right posterolateral thoracotomy, where an incision is made in the skin and extended through the underlying soft tissues. The surgical team retracts the scapula to gain access to the thoracic cavity without disrupting the pleura, the membrane surrounding the lungs. Through retropleural dissection, the lung is retracted, allowing for direct exposure of the esophagus. The mediastinal pleura may be opened as necessary to fully visualize and address the defect in the esophagus. In contrast to CPT® Code 43310, which pertains to esophageal defects without a tracheoesophageal fistula, CPT® Code 43312 specifically addresses cases where the esophagoplasty is performed in conjunction with the repair of a tracheoesophageal fistula. During this procedure, the fistula is divided, and the trachea is sutured to restore its integrity. The esophagus is then meticulously repaired in two layers, with the suture line reinforced using a flap of mediastinal pleura, intercostal muscle, and rib periosteum as needed to ensure a robust and effective repair.
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Esophagoplasty with repair of tracheoesophageal fistula is indicated for the following conditions:
The procedure for esophagoplasty with repair of tracheoesophageal fistula involves several critical steps:
Post-procedure care for patients undergoing esophagoplasty with repair of tracheoesophageal fistula typically includes monitoring for complications such as infection, leakage at the repair site, and respiratory issues. Patients may require a period of recovery in a hospital setting, where they will be observed for any signs of distress or complications. Nutritional support may be necessary, as patients may need to follow a modified diet to allow for healing. Follow-up appointments will be essential to assess the integrity of the repair and the overall recovery process.
| Short Descr | REPAIR ESOPHAGUS AND FISTULA | Medium Descr | ESPHGP THRC APPR W/RPR TRACHEOESOPHGL FSTL | Long Descr | Esophagoplasty (plastic repair or reconstruction), thoracic approach; with repair of tracheoesophageal fistula | 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). | 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. | 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). | 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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| 2003-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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