How To Use CPT Code 43611

CPT 43611 describes the excision of a malignant tumor of the stomach. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43611?

CPT 43611 is used to describe the surgical procedure of removing a cancerous tumor from the stomach. This code is specifically used when the excision is performed to prevent the spread of the tumor or to reduce its size before radiation or chemotherapy treatment.

2. Official Description

The official description of CPT code 43611 is: ‘Excision, local; malignant tumor of stomach.’

3. Procedure

1. The surgeon begins by preparing and anesthetizing the patient.
2. A midline incision is made in the abdominal cavity to access the stomach.
3. Tissue and muscle layers are retracted to provide clear visibility.
4. The duodenum is clamped and transected.
5. The surgeon then carefully frees the stomach from surrounding tissues to locate the tumor.
6. The tumor is excised, ensuring a sufficient margin of normal tissue is removed along with it.
7. The lesser curvature of the stomach, which is the inner inferior margin, is closed in layers.
8. A drainage tube may be left in the abdomen for post-operative care.
9. Hemostasis is achieved, and all instruments are removed.
10. The incision in the abdomen is closed in layers.

4. Qualifying circumstances

CPT 43611 is used for patients with a malignant tumor in the stomach that requires surgical excision. The procedure is performed by a qualified surgeon. The tumor must be confirmed as cancerous, capable of spreading and causing harm if left untreated.

5. When to use CPT code 43611

CPT code 43611 should be used when a surgeon performs a local excision of a malignant tumor in the stomach. It is appropriate when the excision is done to prevent metastasis or reduce the tumor’s size before radiation or chemotherapy treatment.

6. Documentation requirements

To support a claim for CPT 43611, the surgeon must document the following information:

• Patient’s diagnosis of a malignant tumor in the stomach
• Reason for the excision, such as prevention of metastasis or tumor size reduction
• Details of the surgical procedure, including the incision, tissue retraction, tumor excision, and closure
• Any additional procedures performed, such as the placement of a drainage tube
• Confirmation of hemostasis and removal of instruments
• Signature of the performing surgeon

7. Billing guidelines

When billing for CPT 43611, ensure that the excision is performed by a qualified surgeon. Follow the appropriate coding guidelines and documentation requirements. It is important to note that CPT 43611 should not be reported with other codes for partial or total gastrectomy procedures.

8. Historical information

CPT 43611 was added to the Current Procedural Terminology system on January 1, 1994. The code has undergone no updates since its addition. However, it is worth mentioning that Medicare made a change in 2017, adding CPT 43611 to the Inpatient Only (IPO) list.

9. Examples

1. A surgeon performs an excision of a malignant tumor in the stomach to prevent metastasis in a patient.
2. During surgery, the surgeon removes a cancerous tumor from the stomach to reduce its size before initiating chemotherapy.
3. A patient with a malignant tumor in the stomach undergoes a local excision procedure to prepare for radiation therapy.
4. A surgeon performs an excision of a cancerous tumor in the stomach to prevent further spread of the disease.
5. During surgery, the surgeon removes a malignant tumor from the stomach to reduce the bulk of the tumor before starting chemotherapy treatment.
6. A patient with a cancerous tumor in the stomach undergoes a local excision procedure to facilitate subsequent radiation therapy.
7. A surgeon performs an excision of a malignant tumor in the stomach to prevent metastasis and improve the patient’s prognosis.
8. During surgery, the surgeon removes a cancerous tumor from the stomach to reduce the tumor burden before initiating targeted therapy.
9. A patient with a malignant tumor in the stomach undergoes a local excision procedure to optimize the effectiveness of chemotherapy.
10. A surgeon performs an excision of a cancerous tumor in the stomach to prevent further growth and spread of the disease.