I'm not 100% sure on the takedown of the gastrostomy. As for the rest, I would code the entire esophagectomy with CPT 43289. I would include the lysis of adhesions when setting your fee for this unlisted code (You can't bill separately for them but when the work to take them down is significant, you can add modifier 22. Since this is an unlisted code though, don't add the modifier, just increase your fee).
I would also bill 38746 for the mediastinal lymph node dissection. The surgeon should be documenting he/she removed lymph nodes from levels 4,7, and 9 (at a minimum) to bill for this though.
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