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CPT®
43350

CPT® Code 43350
Deleted

Official Description

Esophagostomy, fistulization of esophagus, external; abdominal approach

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

Esophagostomy, specifically the procedure described by CPT® Code 43350, involves the surgical creation of a fistula in the esophagus through an abdominal approach. This procedure is primarily indicated for patients who require an alternative means of nutrition due to conditions that obstruct normal swallowing or esophageal function. The process entails the exteriorization of the proximal (upper) segment of the esophagus, which is brought out through the abdominal wall to form a stoma, while the distal (lower) segment is surgically closed. This stoma allows for the passage of food and fluids directly into the esophagus, facilitating normal eating patterns for the patient. Following the initial surgical intervention, the stoma is allowed to heal for a period of two weeks. After this healing phase, an esophageal tube equipped with a flange is inserted into the stoma. The flange is designed to sit beneath the skin, ensuring that part of the tube remains outside the body, which is then connected to a gastrostomy tube. The procedure is performed using a transhiatal approach, which involves making an incision in the upper abdomen, mobilizing the stomach at the gastroesophageal junction, and splitting the diaphragmatic hiatus to access the lower posterior mediastinum and esophagus. This detailed surgical technique ensures that the esophagus is properly mobilized, divided, and sutured to create a functional stoma for the patient.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

Esophagostomy, as described by CPT® Code 43350, is indicated for patients who have conditions that necessitate an alternative route for nutrition due to esophageal obstruction or dysfunction. The following are specific indications for this procedure:

  • Esophageal Obstruction: Conditions that block the esophagus, preventing normal swallowing.
  • Esophageal Cancer: Tumors that may compromise the ability to ingest food orally.
  • Severe Esophagitis: Inflammation of the esophagus that leads to significant swallowing difficulties.
  • Neuromuscular Disorders: Conditions affecting the muscles and nerves that control swallowing.

2. Procedure

The procedure for esophagostomy involves several critical steps to ensure successful creation of the stoma. Each step is detailed as follows:

  • Step 1: Incision and Mobilization An incision is made in the upper abdomen to access the esophagus. The stomach is then mobilized at the gastroesophageal junction to facilitate the surgical approach.
  • Step 2: Splitting the Diaphragmatic Hiatus The diaphragmatic hiatus is carefully split to expose the lower posterior mediastinum and the esophagus, allowing for adequate access to the esophageal structure.
  • Step 3: Division of the Esophagus The esophagus is mobilized and divided at the appropriate location. This step is crucial for isolating the proximal and distal segments of the esophagus.
  • Step 4: Closure of the Distal End The distal end of the esophagus is sutured closed to prevent any leakage and to secure the integrity of the gastrointestinal tract.
  • Step 5: Exteriorization of the Proximal End The proximal end of the esophagus is exteriorized through the abdominal wall, creating a stoma that will allow for the passage of food and fluids.
  • Step 6: Suturing to the Abdominal Fascia The muscular layers of the esophagus are sutured to the abdominal fascia to secure the stoma in place and ensure proper healing.
  • Step 7: Anastomosis to the Skin Finally, the full thickness of the esophagus is anastomosed to the skin, completing the creation of the stoma.

3. Post-Procedure

After the esophagostomy procedure, the patient will require careful monitoring and post-operative care. The stoma is allowed to heal for approximately two weeks before any further interventions, such as the insertion of an esophageal tube with a flange, are performed. During this healing period, it is essential to maintain proper hygiene around the stoma to prevent infection. Once the esophageal tube is in place, the patient will be educated on how to manage the tube and the connection to the gastrostomy tube. Follow-up appointments will be necessary to monitor the healing process and to ensure that the stoma is functioning as intended.
Short Descr SURGICAL OPENING ESOPHAGUS
Medium Descr ESOPHAGOSTOMY FSTLJ ESOPH XTRNL ABDL APPR
Long Descr Esophagostomy, fistulization of esophagus, external; abdominal approach
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 9 - 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 Not applicable/unspecified.
CCS Clinical Classification 94 - Other OR upper GI therapeutic procedures
Date
Action
Notes
2015-01-01 Deleted Code Deleted
2011-01-01 Changed Short description changed.
Pre-1990 Added Code added.
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