How To Use CPT Code 43500

CPT 43500 describes a procedure known as gastrotomy, which involves making an incision through the abdomen and into the stomach to explore the area for a foreign body. If a foreign body is found, it is removed. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43500?

CPT 43500 is a code used to describe the gastrotomy procedure. During this procedure, a healthcare provider makes an incision in the abdomen and exposes the stomach. Another incision is made in the stomach to explore the entire organ. The purpose of this exploration is to locate and remove any foreign bodies that may be present. If a foreign body is found, the provider uses surgical forceps to grasp and remove it. The procedure may also involve leaving a tube in the stomach for continued drainage, which is brought out through the abdominal incision. The provider then checks for bleeding, removes any instruments, and closes the incision in the abdomen.

2. Official Description

The official description of CPT code 43500 is: ‘Gastrotomy; with exploration or foreign body removal.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes a small incision in the abdomen to expose the stomach.
3. Another incision is made in the stomach to explore the entire organ.
4. If a foreign body is found, the provider isolates it and removes it using surgical forceps.
5. If continued drainage is necessary, the provider leaves a tube in the stomach and closes the stomach incision around the tube, bringing it out through the abdominal incision.
6. The provider checks for bleeding, removes any instruments, and closes the incision in the abdomen.

4. Qualifying circumstances

CPT 43500 is performed when a patient has a foreign body in the upper gastrointestinal (GI) tract, typically swallowed or introduced through traumatic injuries. The procedure is usually performed after attempts to retrieve the foreign object by endoscopy have failed or when endoscopy is contraindicated based on X-ray results. The provider must have the necessary skills and qualifications to perform the gastrotomy procedure.

5. When to use CPT code 43500

CPT code 43500 should be used when a gastrotomy procedure is performed to explore the stomach and remove a foreign body. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure does not involve gastrotomy or foreign body removal, a different code should be used.

6. Documentation requirements

To support a claim for CPT 43500, the healthcare provider must document the following information:

• Patient’s medical history and reason for the gastrotomy procedure
• Details of the procedure, including the incisions made and the exploration of the stomach
• Description of any foreign bodies found and the method of removal
• Documentation of any additional procedures performed, such as leaving a tube in the stomach for drainage
• Confirmation of bleeding control and closure of the incision
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43500, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be reported with modifier 51 if multiple procedures are performed during the same session. It is also important to follow any additional guidelines provided by insurance payers or regulatory bodies.

8. Historical information

CPT 43500 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes a gastrotomy procedure to explore the stomach and remove a swallowed foreign object.
2. A healthcare provider performs a gastrotomy to investigate and remove a foreign body that has caused gastrointestinal complications.
3. A patient with a history of trauma undergoes a gastrotomy to remove a foreign body that was introduced into the GI tract.
4. A gastrotomy procedure is performed to explore the stomach and remove a foreign object that has caused severe abdominal pain in a patient.
5. A healthcare provider performs a gastrotomy to remove a foreign body that has become lodged in the stomach and is causing digestive issues for the patient.
6. A patient undergoes a gastrotomy procedure to investigate and remove a foreign object that has caused bleeding in the stomach.
7. A healthcare provider performs a gastrotomy to remove a foreign body that has caused an obstruction in the upper GI tract.
8. A patient with a history of swallowing foreign objects undergoes a gastrotomy to remove a lodged object that cannot be retrieved by endoscopy.
9. A gastrotomy procedure is performed to explore the stomach and remove a foreign body that has caused infection in a patient.
10. A healthcare provider performs a gastrotomy to remove a foreign object that has perforated the stomach wall and is causing internal bleeding.