How To Use CPT Code 43605

CPT 43605 describes the procedure of performing an open biopsy on the stomach through a laparotomy. This article will cover the official description, procedure details, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43605?

CPT 43605 can be used to describe the surgical procedure of performing an open biopsy on the stomach through a laparotomy. This code is used when a provider makes an incision in the upper abdominal area, examines the abdominal cavity, makes an incision into the stomach, and takes a tissue sample from a suspicious area for biopsy. The purpose of this procedure is to determine the origin and nature of the lesion, whether it is malignant or benign.

2. Official Description

The official description of CPT code 43605 is: ‘Biopsy of stomach, by laparotomy.’

3. Procedure

1. The provider prepares the patient and administers anesthesia.
2. An incision is made in the upper abdominal area.
3. The incision is spread open and held with retractors to allow direct examination of the abdominal cavity.
4. An incision is made into the stomach.
5. A tissue sample is taken from a suspicious area for biopsy.
6. The biopsy area is checked for bleeding and, if none is found, the incision in the stomach is closed in layers.
7. The suture line is checked for bleeding, instruments are removed, and the incision in the abdomen is closed.

4. Qualifying circumstances

CPT 43605 is performed when there is a suspicious lesion in the stomach that requires a biopsy to determine its nature. The procedure is typically done when there is a need to assess whether the lesion is malignant or benign. The patient must be appropriately prepped and anesthetized for the procedure. The provider must have a reason to suspect the presence of a lesion in the stomach that requires further investigation.

5. When to use CPT code 43605

CPT code 43605 should be used when a provider performs an open biopsy on the stomach through a laparotomy. It is appropriate to use this code when there is a need to obtain a tissue sample from a suspicious area in the stomach for further evaluation. This code should not be used for other procedures or when a different approach is used for the biopsy.

6. Documentation requirements

To support a claim for CPT 43605, the provider must document the following information:

• Reason for the biopsy and the presence of a suspicious lesion in the stomach
• Details of the procedure, including the incision made, examination of the abdominal cavity, incision into the stomach, and tissue sample taken
• Confirmation of the biopsy area being checked for bleeding and closure of the incisions
• Any complications or additional procedures performed during the same session
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43605, ensure that the procedure performed matches the description of the code. Use additional codes if other procedures or services were provided during the same session. It is important to follow the specific guidelines provided by the payer to ensure accurate and appropriate billing.

8. Historical information

CPT 43605 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2011, with an updated description. It is also important to note that CPT 43605 is listed as an inpatient-only (IPO) procedure for Medicare.

9. Examples

1. A provider performs an open biopsy on a patient’s stomach to determine the nature of a suspicious lesion.
2. During a laparotomy, a surgeon takes a tissue sample from a suspicious area in the stomach for biopsy.
3. A patient undergoes an open biopsy procedure on the stomach to assess the presence of a malignant or benign lesion.
4. A provider performs an open biopsy on a patient’s stomach to investigate a suspicious mass found during imaging tests.
5. During a laparotomy, a surgeon takes a tissue sample from a suspicious area in the stomach to determine the origin of the lesion.
6. A patient undergoes an open biopsy procedure on the stomach to evaluate a suspicious ulcer.
7. A provider performs an open biopsy on a patient’s stomach to determine if a tumor is malignant or benign.
8. During a laparotomy, a surgeon takes a tissue sample from a suspicious area in the stomach to confirm the presence of cancer.
9. A patient undergoes an open biopsy procedure on the stomach to investigate a suspicious growth.
10. A provider performs an open biopsy on a patient’s stomach to assess the nature of a suspicious lesion detected during an endoscopy.