How To Use CPT Code 43659

CPT 43659 is an unlisted laparoscopy procedure code for the stomach, used when no specific code is available. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 43659 procedures.

1. What is CPT 43659?

CPT 43659 is an unlisted laparoscopy procedure code for the stomach. It is used when a new or unusual laparoscopic procedure on the stomach is performed, and there is no specific code available to represent the service provided. Medical coders and billers should use this code only when no other appropriate code exists for the procedure performed.

2. 43659 CPT code description

The official description of CPT code 43659 is: “Unlisted laparoscopy procedure, stomach.”

3. Procedure

1. The provider makes several small incisions in the abdomen.
2. The abdomen is inflated with carbon dioxide (CO2) for better exposure.
3. A scope is inserted through one of the incisions to examine the abdomen.
4. Ports are placed in the other incisions to keep them open.
5. Instruments are inserted through the other incisions to perform the procedure on the stomach.
6. The procedure is performed, which may vary depending on the specific case.
7. Ports are removed at the conclusion of the procedure.
8. The small incisions are closed with staples or one or two sutures.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 43659 services are those who require a new or unusual laparoscopic procedure on the stomach that is not represented by any of the standard and active CPT codes available. The provider should consult with the patient and review their medical history, symptoms, and any diagnostic tests to determine if the unlisted laparoscopic procedure is necessary and appropriate for the patient’s condition.

5. When to use CPT code 43659

It is appropriate to bill the 43659 CPT code when a new or unusual laparoscopic procedure on the stomach is performed, and there is no specific code available to represent the service provided. Medical coders and billers should use this code only when no other appropriate code exists for the procedure performed. It is essential to consult the provider, if possible, to ensure that proper documentation has been done before billing for an unlisted procedure.

6. Documentation requirements

When billing for CPT 43659, it is crucial to provide proper documentation to support the claim. This includes a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. The cover letter should include one or more similar codes and compare the service provided to those codes to justify the claim amount being billed. Additionally, the operative notes and/or other relevant documentation should be included to strengthen the claim and avoid a possible denial. Payers will consider claims with unlisted procedure codes on a case-by-case basis and determine payment based on the documentation provided.

7. Billing guidelines

When billing for CPT code 43659, it is essential to follow the CPT guidelines and rules. These include not choosing a code that merely approximates the service provided and reporting the service using only the appropriate unlisted procedure code if no specific procedure or service code exists. A Category III code must be reported when available in place of an unlisted procedure code. It is also crucial to submit a cover letter and proper documentation, as mentioned in the documentation requirements section, to support the claim and avoid denial.

8. Historical information

CPT 43659 was added to the Current Procedural Terminology system on January 1, 2000. There have been no updates to the code since its addition.

9. Similar codes to CPT 43659

Five similar codes to CPT 43659 and how they differentiate from CPT 43659 are as follows:

1. CPT 43644: This code is for a laparoscopic gastric bypass procedure, which is a specific type of weight loss surgery.
2. CPT 43645: This code is for a laparoscopic gastric restrictive procedure, another specific type of weight loss surgery.
3. CPT 43620: This code is for a gastrectomy, which is the surgical removal of all or part of the stomach.
4. CPT 43621: This code is for a gastrectomy with Roux-en-Y reconstruction, a specific type of gastric bypass surgery.
5. CPT 43633: This code is for a subtotal gastrectomy with Roux-en-Y reconstruction, a specific type of gastric bypass surgery that involves removing part of the stomach.

10. Examples

Here are 10 detailed examples of CPT code 43659 procedures:

1. Laparoscopic removal of a large gastric polyp that is not amenable to endoscopic removal.
2. Laparoscopic repair of a gastric perforation not covered by other specific codes.
3. Laparoscopic resection of a gastric duplication cyst.
4. Laparoscopic lysis of adhesions involving the stomach that is causing obstruction or pain.
5. Laparoscopic resection of a gastric tumor not covered by other specific codes.
6. Laparoscopic revision of a previous gastric surgery not covered by other specific codes.
7. Laparoscopic drainage of a gastric abscess.
8. Laparoscopic repair of a gastrogastric fistula.
9. Laparoscopic treatment of a gastric volvulus.
10. Laparoscopic resection of a portion of the stomach for a rare congenital anomaly.