Summary & Overview
CPT 43287: Laparoscopic and Thoracoscopic Esophagectomy with Esophagogastrostomy
CPT code 43287 denotes a combined minimally invasive esophagectomy: laparoscopic mobilization and resection of the lower esophagus and proximal stomach followed by thoracoscopic mobilization of the upper esophagus and an esophagogastrostomy. This procedure is used for malignant and select benign esophageal conditions requiring resection and reconstruction and is clinically significant because it represents a complex, multi-cavity operative approach that can affect surgical outcomes, resource utilization, and postoperative care pathways nationally. Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how CPT code 43287 is defined clinically, typical sites of service, relevant billing considerations, commonly used modifiers, and the payer landscape. The publication also summarizes expected service line placement (surgical/inpatient) and clinical context for procedural indication. Where available, benchmarking information and payer-specific policy trends related to coverage, prior authorization, and site-of-service guidance are presented to help billing, coding, and surgical teams understand administrative expectations for this complex operative code. Data not available in the input are noted as such in relevant sections.
Billing Code Overview
CPT code 43287 describes a combined minimally invasive esophagectomy in which the surgeon performs a laparoscopic mobilization of the lower esophagus and proximal stomach, removes approximately two-thirds of the lower esophagus and part of the upper stomach, then completes mobilization of the upper two-thirds of the esophagus and performs an esophagogastrostomy using a thoracoscopic approach. The description notes that a pyloric drainage procedure may or may not be performed during the laparoscopic portion.
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Service type: Combined laparoscopic and thoracoscopic esophagectomy with esophagogastrostomy
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Typical site of service: Operating room, inpatient or same-day admission depending on clinical need and payer policies
Clinical & Coding Specifications
Clinical Context
A 62-year-old male with locally advanced distal esophageal adenocarcinoma presents after staging imaging (CT chest/abdomen and PET) demonstrating a tumor involving the lower third of the esophagus with proximal gastric extension and no distant metastases. He completed neoadjuvant chemoradiation and is scheduled for a combined minimally invasive esophagectomy using laparoscopic mobilization of the abdominal esophagus and stomach, followed by thoracoscopic mobilization of the upper thoracic esophagus and an intrathoracic esophagogastrostomy. The operative team includes a thoracic surgeon and an anesthesiologist; the procedure may include intraoperative pyloric drainage at the surgeon's discretion. Typical workflow: preoperative consent and staging review, general endotracheal anesthesia with single-lumen or dual-lumen tube per anesthesiology preference, laparoscopic abdominal port placement with mobilization of the stomach and lower esophagus, creation of gastric conduit, optional pyloric procedure, repositioning and thoracoscopic mobilization of upper esophagus, esophagogastrostomy (intrathoracic anastomosis), hemostasis, placement of drains, and transfer to recovery or ICU for postoperative care. Typical site of service is an inpatient operating room in a tertiary hospital with thoracic surgery capability; service type is a major surgical procedure (complex, combined laparoscopic and thoracoscopic esophagectomy). Typical patient scenario includes oncology, dysphagia, weight loss, preoperative nutrition optimization, and perioperative intensive monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | (No standard CMS meaning; placeholder in input) |