How To Use CPT Code 43520

CPT 43520 describes the cutting of the pyloric muscle, specifically for the treatment of pyloric stenosis in infants. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43520?

CPT 43520 is used to describe a surgical procedure that involves cutting into the hypertrophied pyloric muscle to correct pyloric stenosis. Pyloric stenosis is a condition characterized by the narrowing of the part of the stomach that leads into the small intestine, resulting in projectile vomiting in infants. The procedure is commonly known as a Fredet-Ramstedt type operation or pyloromyotomy.

2. Official Description

The official description of CPT code 43520 is: ‘Pyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type operation).’ It is important to note that modifier 63 should not be reported in conjunction with this code.

3. Procedure

1. When performing CPT 43520, the provider begins by making a small incision in the right side of the abdomen, just below the rib cage.
2. Gentle traction is then applied to the omentum, transverse colon, stomach, and antrum to expose the pylorus.
3. The provider identifies a spot on the anterior pylorus without blood supply and makes a lengthwise incision in the pyloric tissue, ensuring not to cut through the mucosa.
4. The cut muscle is gently spread apart, and the outer covering of the muscle and fascia are closed in layers.
5. The provider checks for any bleeding, removes any instruments, and closes the incision in the abdomen.

4. Qualifying circumstances

CPT 43520 is performed to correct pyloric stenosis, a condition that causes projectile vomiting in infants. It is important to note that modifier 63 should not be reported with this code.

5. When to use CPT code 43520

CPT code 43520 should be used when a provider performs a pyloromyotomy, specifically for the treatment of pyloric stenosis in infants. It is important to ensure that the procedure is performed on the hypertrophied pyloric muscle and that the patient meets the criteria for pyloric stenosis.

6. Documentation requirements

To support a claim for CPT 43520, the provider must document the following information:

• Patient’s diagnosis of pyloric stenosis
• Details of the procedure performed, including the incision site and the cutting of the pyloric muscle
• Any complications or additional procedures performed
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43520, ensure that the procedure is performed for the treatment of pyloric stenosis in infants. Modifier 63 should not be reported with this code. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT 43520 was added to the Current Procedural Terminology system on January 1, 1990. It is important to note that in 2017, it was added under the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A provider performs a pyloromyotomy on an infant with pyloric stenosis, correcting the narrowing of the pyloric muscle.
2. During surgery, the provider makes an incision in the abdomen and cuts the hypertrophied pyloric muscle to treat pyloric stenosis in an infant.
3. A baby with projectile vomiting undergoes a pyloromyotomy, where the provider cuts the pyloric muscle to alleviate the symptoms of pyloric stenosis.
4. Using a Fredet-Ramstedt type operation, the provider performs a pyloromyotomy on an infant with pyloric stenosis, allowing for proper passage of stomach contents into the small intestine.
5. A surgeon performs a pyloromyotomy on an infant with pyloric stenosis, relieving the obstruction caused by the hypertrophied pyloric muscle.
6. During the procedure, the provider cuts into the pyloric muscle to correct pyloric stenosis in an infant, ensuring proper digestion and alleviating symptoms.
7. A baby with feeding difficulties undergoes a pyloromyotomy, where the provider cuts the pyloric muscle to treat pyloric stenosis and improve the passage of food from the stomach to the small intestine.
8. A surgeon performs a Fredet-Ramstedt type operation on an infant with pyloric stenosis, cutting the hypertrophied pyloric muscle to restore normal function.
9. Using a lengthwise incision in the pyloric tissue, the provider performs a pyloromyotomy on an infant with pyloric stenosis, allowing for proper food passage and alleviating symptoms.
10. A baby with persistent vomiting undergoes a pyloromyotomy, where the provider cuts the pyloric muscle to treat pyloric stenosis and improve the infant’s feeding ability.