CPT® Code 43496

The CPT® Code 43496 refers to a surgical procedure known as a free jejunum transfer with microvascular anastomosis. This procedure is commonly described as a free jejunal graft or flap. It involves the surgical harvesting of a segment of the jejunum, which is a part of the small intestine, to be used for reconstruction or repair in another area of the body. The process begins with an incision in the abdomen to access the jejunum. The surgeon carefully exposes the jejunum and identifies the specific segment that will be harvested. It is crucial to mark the distal end of the graft segment to ensure that it is oriented correctly, allowing for normal peristalsis, which is the wave-like muscle contractions that move food through the digestive tract. During the procedure, the artery that supplies blood to the segment of jejunum being harvested is located, and the associated blood vessels are meticulously dissected back to their branching points. These vessels are then suture ligated and divided to prepare the graft for removal. The jejunum is subsequently divided, and the graft segment is excised along with its supplying blood vessels. To maintain continuity of the small bowel, the remaining distal and proximal segments of the jejunum are anastomosed, or surgically connected. Once the graft segment is removed, it is transferred to the designated site where it will be placed. This transfer site is prepared as part of a separately reportable procedure. The orientation of the jejunal graft is critical, and the surgeon ensures that the marked distal end is correctly positioned. The serosal layer of the jejunum is then secured to the surrounding tissue to relieve tension on the anastomosis sites. Finally, the proximal and distal ends of the graft are anastomosed to the remaining esophageal or bowel segments, followed by the performance of microvascular anastomosis, which involves connecting the jejunal blood vessels to the vessels at the anastomosis site to restore blood flow.