General Surgery Coding Alert

Question: The surgeon performed an open esophagectomy of the abdominal esophagus and removed a portion of the proximal stomach, reconnecting the remaining esophagus to the stomach. The patient had been diagnosed with Barrett’s esophagus, but the pathology report on this surgical specimen shows adenocarcinoma. How should we code the case?

Ohio Subscriber

Answer: The procedure you describe is 43122 (Partial esophagectomy, thoracoabdominal or abdominal approach, with or without proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty). You’ve documented a partial esophagectomy with proximal gastrectomy. Although you don’t mention that the surgeon widened the pyloris, a step that is often part of the procedure, that doesn’t change your code choice. The code states, “with or without pyrolplasty.”

Regarding the diagnosis, you should report C15.5 (Malignant neoplasm of lower third of esophagus). Your documentation shows that the surgeon removed the abdominal esophagus, which equates to the lower third in ICD-10. Notice that you must have the pathology report before you can assign a final diagnosis.

Adenocarcinoma is more common following a diagnosis of Barrett’s esophagus, because the normal esophageal cells are squamous cells, which give rise to squamous cell carcinoma. Only when an area of esophageal squamous cells have been replaced by gland cells, which occurs in Barrett’s esophagus, can adenocarcinoma arise.

C15.5 stands: Because both adenocarcinoma and squamous cell carcinoma are malignant tumor types, you would choose C15.5 for either type of cancer at this site.