How To Use CPT Code 43620

CPT 43620 describes a surgical procedure that involves creating a connection between the esophagus and intestine after the removal of the stomach. This article will provide an overview of CPT code 43620, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43620?

CPT 43620 is a code used to describe a surgical procedure in which a provider creates a connection between the esophagus and intestine following the excision of the stomach. This procedure is typically performed when the removal of the stomach is necessary due to certain medical conditions or diseases.

2. Official Description

The official description of CPT code 43620 is: ‘Gastrectomy, total; with esophagoenterostomy.’

3. Procedure

1. The provider begins by making an upper left paramedian incision.
2. They then mobilize the spleen, splenic vessels, and the tail and body of the pancreas from left to right.
3. A retroperitoneal procedure is performed, working behind the peritoneum.
4. The provider resects the stomach along with the lesser and greater omentum and lymph nodes around the celiac axis.
5. They ligate the left gastric, right gastric, and epiploic arteries.
6. After the complete removal of the stomach, the provider closes the cut edge of the pancreas with sutures.
7. Finally, they create an esophagoenterostomy, which is a connection between the esophagus and intestine, to maintain the continuity of the alimentary canal.

4. Qualifying circumstances

CPT 43620 is typically performed on patients who require the removal of the entire stomach and the creation of an esophagoenterostomy. This procedure is often necessary for conditions such as gastric cancer or other diseases that affect the stomach. It is important to note that this procedure should only be performed by a qualified healthcare professional with the appropriate expertise and training.

5. When to use CPT code 43620

CPT code 43620 should be used when a provider performs a total gastrectomy and creates an esophagoenterostomy. This code is specific to cases where the entire stomach is removed, and the connection between the esophagus and intestine is established. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT code 43620, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the procedure
• Details of the surgical approach and technique used
• Date of the procedure
• Any additional procedures performed during the same operative session
• Any complications or unexpected findings
• Signature of the performing provider

7. Billing guidelines

When billing for CPT code 43620, it is important to ensure that the procedure performed aligns with the official description of the code. Additionally, it is crucial to follow any specific billing guidelines provided by the payer or relevant coding guidelines. It is also important to accurately document any additional procedures performed during the same operative session to support appropriate billing.

8. Historical information

CPT code 43620 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone no updates since its addition. However, it is important to stay updated with any changes or revisions to coding guidelines or payer requirements.

9. Examples

1. A patient with gastric cancer undergoes a total gastrectomy with esophagoenterostomy to remove the entire stomach and establish a connection between the esophagus and intestine.
2. A provider performs a total gastrectomy with esophagoenterostomy on a patient with a severe peptic ulcer disease.
3. A patient with a rare gastrointestinal disorder requires a total gastrectomy with esophagoenterostomy to manage their condition.
4. A provider performs a total gastrectomy with esophagoenterostomy on a patient with a large gastric polyp that cannot be effectively treated with other methods.
5. A patient with a hereditary gastric cancer syndrome undergoes a total gastrectomy with esophagoenterostomy as a preventive measure.
6. A provider performs a total gastrectomy with esophagoenterostomy on a patient with a perforated gastric ulcer.
7. A patient with a malignant gastrointestinal stromal tumor requires a total gastrectomy with esophagoenterostomy to remove the tumor and establish a new digestive pathway.
8. A provider performs a total gastrectomy with esophagoenterostomy on a patient with a large gastric leiomyoma that is causing symptoms and complications.
9. A patient with a rare autoimmune disorder undergoes a total gastrectomy with esophagoenterostomy to manage their condition and improve their quality of life.
10. A provider performs a total gastrectomy with esophagoenterostomy on a patient with a severe case of gastric outlet obstruction.