How To Use CPT Code 43501

CPT 43501 describes a surgical procedure involving the creation of an incision in the stomach and the repair of a bleeding ulcer. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43501?

CPT 43501 is a code used to describe a surgical procedure that involves making an incision in the stomach and suturing a bleeding ulcer. This procedure is performed by a healthcare provider and is used to treat ulcers that are bleeding or have eroded or perforated through the wall of the stomach or duodenum.

2. Official Description

The official description of CPT code 43501 is: ‘Gastrotomy; with suture repair of bleeding ulcer.’

3. Procedure

1. The healthcare provider prepares the patient for the procedure and ensures they are appropriately prepped and anesthetized.
2. An incision is made through the anterior abdominal wall and then into the stomach.
3. The provider identifies the area of bleeding and sutures the bleeding vessel.
4. The stomach is irrigated, or washed out, and the irrigating fluid is suctioned out.
5. The provider reexamines the area to ensure there is no more bleeding.
6. If continued drainage is necessary, a tube may be placed in the stomach and the stomach incision is closed around it, with the tube brought out through the abdominal incision.
7. The provider checks once again for bleeding, removes any instruments, and closes the incision in the abdomen.

4. Qualifying circumstances

CPT 43501 is used for patients who have a bleeding ulcer or an ulcer that has eroded or perforated through the wall of the stomach or duodenum. The procedure is performed by a healthcare provider and requires the patient to be appropriately prepped and anesthetized. It is important to note that this procedure is typically used for ulcers that require surgical treatment due to bleeding or severe complications.

5. When to use CPT code 43501

CPT code 43501 should be used when a healthcare provider performs a gastrotomy procedure with suture repair of a bleeding ulcer. This code is appropriate when the provider makes an incision in the stomach and sutures the bleeding vessel to stop the bleeding. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT 43501, the healthcare provider must document the following information:

• Patient’s diagnosis of a bleeding ulcer or an ulcer that has eroded or perforated through the wall of the stomach or duodenum
• Details of the procedure, including the incision made in the stomach and the suturing of the bleeding vessel
• Documentation of any additional steps taken during the procedure, such as stomach irrigation or placement of a drainage tube
• Date of the procedure
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 43501, it is important to ensure that the procedure meets the specific criteria outlined in the official description of the code. The healthcare provider should use the appropriate CPT code based on the specific procedure performed. It is also important to follow any additional billing guidelines provided by insurance companies or regulatory bodies.

8. Historical information

CPT 43501 was added to the Current Procedural Terminology system on January 1, 1990. It was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A healthcare provider performs a gastrotomy procedure with suture repair of a bleeding ulcer in a patient with a history of gastric ulcers.
2. A patient presents with a perforated duodenal ulcer, and a healthcare provider performs a gastrotomy procedure with suture repair to address the complication.
3. A healthcare provider performs a gastrotomy procedure with suture repair of a bleeding ulcer in a patient who has failed to respond to medical management.
4. A patient with a bleeding gastric ulcer undergoes a gastrotomy procedure with suture repair performed by a healthcare provider to stop the bleeding.
5. A healthcare provider performs a gastrotomy procedure with suture repair of a bleeding ulcer in a patient with a history of peptic ulcers.
6. A patient with a bleeding duodenal ulcer undergoes a gastrotomy procedure with suture repair performed by a healthcare provider to address the complication.
7. A healthcare provider performs a gastrotomy procedure with suture repair of a bleeding ulcer in a patient with a history of gastrointestinal bleeding.
8. A patient presents with a perforated gastric ulcer, and a healthcare provider performs a gastrotomy procedure with suture repair to address the complication.
9. A healthcare provider performs a gastrotomy procedure with suture repair of a bleeding ulcer in a patient who requires immediate surgical intervention.
10. A patient with a bleeding duodenal ulcer undergoes a gastrotomy procedure with suture repair performed by a healthcare provider to stop the bleeding.