Summary & Overview
CPT 43117: Esophagectomy, Distal Two-Thirds with Gastric Reconstruction
CPT code 43117 represents a transthoracic and transabdominal esophagectomy in which the distal two thirds of the esophagus are removed and the remaining esophagus is connected to the stomach; partial proximal gastrectomy and widening of the gastroesophageal hiatus may also be performed. This major thoracoabdominal surgical code is clinically significant nationwide because it captures complex care for esophageal malignancy, severe benign disease, and other indications that require esophageal resection and reconstruction, with implications for inpatient surgical resource use and perioperative risk management.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for the procedure, typical sites of service, commonly reported modifiers, and the types of benchmarks and policy topics that affect coverage and payment for high-acuity inpatient surgical services. The publication summarizes expected service lines, typical care settings, and areas where coding, documentation, and payer policies intersect for major esophageal surgery. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 43117 describes a surgical procedure in which the surgeon removes the distal two thirds of the esophagus, with optional partial resection of the proximal stomach. The remaining esophagus is anastomosed to the stomach within the chest, and the gastroesophageal hiatus may be widened during the operation. The procedure is performed using both abdominal and chest incisions.
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Service type: Surgical resection and reconstruction of the esophagus (esophagectomy with gastric conduit creation)
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Typical site of service: Inpatient hospital, performed in operating room with postoperative inpatient care
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with a long history of heavy smoking and progressive dysphagia presents with weight loss and odynophagia. Endoscopy with biopsy confirms a distal esophageal adenocarcinoma involving the lower two-thirds of the esophagus with extension toward the gastroesophageal junction. After staging (CT chest/abdomen, PET as indicated) and multidisciplinary tumor board review, the patient is scheduled for transthoracic esophagectomy with gastric conduit reconstruction and pyloric intervention. In the operating room, the surgeon performs an abdominal incision to mobilize the stomach, creates a tubularized gastric conduit, may perform a partial gastrectomy if tumor extends to the proximal stomach, and then through a right thoracotomy or thoracoscopy removes the distal two-thirds of the esophagus. The remaining stomach is pulled into the chest and an intrathoracic esophagogastric anastomosis is created; the pyloric channel may be widened (pyloroplasty or pyloromyotomy) to aid gastric emptying. Inpatient care includes intensive monitoring postoperatively, pain control, respiratory therapy, enteral nutrition support, and staged advancement of diet after radiographic confirmation of anastomotic integrity. Typical sites of service are the hospital operating room for the procedure and an acute care inpatient stay for recovery and postoperative management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier — standard reporting | Use for routine reporting when no special circumstances apply. |