How To Use CPT Code 43631

CPT 43631 describes the partial gastrectomy procedure, specifically the excision of the diseased portion of the stomach and the reconnection of the remaining stomach to the duodenum. 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 43631?

CPT 43631 is used to describe a surgical procedure in which the provider removes a portion of the stomach and reconnects the remaining stomach to the duodenum. This procedure is typically performed on patients with stomach cancer or other conditions that require the removal of a diseased portion of the stomach.

2. Official Description

The official description of CPT code 43631 is: ‘Gastrectomy, partial, distal; with gastroduodenostomy.’

3. Procedure

1. The provider begins by making an incision in the abdomen, typically from the lower end of the sternum to the umbilicus.
2. Retractors are used to hold the incision open, allowing for exploration of the abdomen.
3. The provider cuts through the peritoneum over the duodenum to free up the stomach and the first part of the duodenum.
4. The duodenum is divided between clamps just below the pylorus, and the lower cut end is covered with gauze for further anastomosis.
5. The provider then joins the cut ends of the stomach and the duodenum without tension.
6. If necessary, a drainage tube may be placed in the abdomen and brought out through a separate stab wound.
7. The provider checks for bleeding, removes any instruments, and closes the incision in the abdomen.

4. Qualifying circumstances

CPT 43631 is performed on patients who require the removal of a diseased portion of the stomach and the reconnection of the remaining stomach to the duodenum. This procedure is commonly performed on patients with stomach cancer. It is important to review the operative note to confirm that the provider creates a surgical passageway between the stomach and the duodenum.

5. When to use CPT code 43631

CPT code 43631 should be used when the provider performs a partial gastrectomy with gastroduodenostomy. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure does not involve the reconnection of the stomach to the duodenum, a different code should be used.

6. Documentation requirements

To support a claim for CPT 43631, the provider must document the following information:

• Patient’s diagnosis necessitating the partial gastrectomy
• Details of the procedure, including the specific portions of the stomach removed and the anastomosis performed
• 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 43631, ensure that the procedure meets the criteria outlined in the code description. It is important to review the operative note to confirm that the gastroduodenostomy is performed. Additionally, be aware of any additional procedures performed during the same operative session and report them accordingly. It is also important to follow any specific billing guidelines provided by payers or regulatory bodies.

8. Historical information

CPT 43631 was added to the Current Procedural Terminology system on January 1, 1994. The code was later added to the Inpatient Only (IPO) list for Medicare in 2017.

9. Examples

1. A patient with stomach cancer undergoes a partial gastrectomy with gastroduodenostomy to remove the diseased portion of the stomach and reconnect the remaining stomach to the duodenum.
2. A provider performs a partial gastrectomy with gastroduodenostomy on a patient with a gastric ulcer to alleviate symptoms and promote healing.
3. A patient with a gastrointestinal stromal tumor requires a partial gastrectomy with gastroduodenostomy to remove the tumor and restore normal digestive function.
4. A provider performs a partial gastrectomy with gastroduodenostomy on a patient with a perforated gastric ulcer to repair the damage and prevent further complications.
5. A patient with severe gastric bleeding undergoes a partial gastrectomy with gastroduodenostomy to stop the bleeding and restore normal gastrointestinal function.
6. A provider performs a partial gastrectomy with gastroduodenostomy on a patient with a benign gastric tumor to remove the tumor and prevent future complications.
7. A patient with a gastric polyp requires a partial gastrectomy with gastroduodenostomy to remove the polyp and prevent the development of cancer.
8. A provider performs a partial gastrectomy with gastroduodenostomy on a patient with a gastric stricture to alleviate symptoms and improve the patient’s ability to eat and digest food.
9. A patient with a gastric outlet obstruction undergoes a partial gastrectomy with gastroduodenostomy to remove the obstruction and restore normal gastrointestinal function.
10. A provider performs a partial gastrectomy with gastroduodenostomy on a patient with a gastric fistula to repair the abnormal connection and restore normal digestive function.