How To Use CPT Code 43632

CPT 43632 describes a specific surgical procedure involving the partial removal of the stomach and the creation of a connection between the remaining portion of the stomach and the jejunum. This article will provide an overview of CPT code 43632, 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 43632?

CPT 43632 is a code used to describe a surgical procedure that involves the removal of a diseased portion of the stomach and the reconnection of the remaining stomach to the jejunum. This procedure is typically performed in patients who have been diagnosed with stomach cancer. It is important to note that this code specifically refers to the partial removal of the stomach and the creation of a gastrojejunostomy.

2. Official Description

The official description of CPT code 43632 is: ‘Gastrectomy, partial, distal; with gastrojejunostomy.’

3. Procedure

1. The surgeon gains access to the stomach through a right upper paramedian incision.
2. The peritoneum is opened to one side of the falciform ligament.
3. The surgeon examines the stomach and duodenum to determine the extent of the pathology.
4. The greater omentum is detached from the stomach by dividing it between artery forceps applied close to the greater curvature.
5. The lesser omentum is detached from the lesser curvature.
6. The surgeon clamps the stomach to tense the left gastric vessels and carefully clamps, dissects, and ligates these vessels.
7. A line is selected for the division of the stomach to remove the distal half.
8. Loose tissues above the proposed line of transection are trimmed off from the greater and lesser curvatures.
9. The transverse mesocolon is split vertically through an avascular area to enter the lesser sac.
10. The posterior wall of the stomach is drawn out through the split in the mesocolon, and Allis tissue forceps are applied to the fold.
11. Occlusion clamps are applied to prevent bleeding or secretions from disturbing the anastomosis.
12. The first loop of the jejunum, located near the tail of the pancreas, is picked up and placed by the side of the posterior wall of the stomach.
13. An isoperistaltic anastomosis is formed by positioning the proximal part of the jejunum near the lesser curvature and the distal part near the greater curvature.
14. The opening of the transverse mesocolon is closed, and the closure is checked for security and bleeding.
15. The abdominal incision is closed.

4. Qualifying circumstances

CPT 43632 is typically performed in patients with stomach cancer who require the removal of a portion of their stomach. The procedure involves the creation of a gastrojejunostomy, which is the connection between the remaining stomach and the jejunum. It is important to note that this procedure should only be performed by a qualified surgeon with experience in performing gastrectomies.

5. When to use CPT code 43632

CPT code 43632 should be used when a surgeon performs a partial gastrectomy with a gastrojejunostomy. This code is specifically for the creation of a connection between the remaining stomach and the jejunum. It is important to note that this code should not be used for other types of gastrectomies or procedures involving different anatomical structures.

6. Documentation requirements

To support a claim for CPT code 43632, the surgeon must document the following information:

• Patient’s diagnosis and the need for a partial gastrectomy
• Details of the procedure, including the specific steps performed
• Date of the surgery
• Any complications or unexpected findings during the procedure
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT code 43632, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The surgeon should be qualified and experienced in performing gastrectomies, and the procedure should involve the creation of a gastrojejunostomy. It is also important to follow any additional guidelines or requirements set forth by the payer or insurance company. It is recommended to review the specific billing guidelines and requirements for CPT code 43632 to ensure accurate and appropriate billing.

8. Historical information

CPT code 43632 was added to the Current Procedural Terminology system on January 1, 1994. The code has not undergone any updates or changes since its addition.

9. Examples

1. A surgeon performs a partial gastrectomy with a gastrojejunostomy in a patient diagnosed with stomach cancer.
2. A patient with a large gastric tumor undergoes a partial gastrectomy with a gastrojejunostomy to remove the diseased portion of the stomach.
3. A surgeon performs a partial gastrectomy with a gastrojejunostomy in a patient with a history of stomach ulcers.
4. A patient with a gastric polyp undergoes a partial gastrectomy with a gastrojejunostomy to remove the polyp and prevent further complications.
5. A surgeon performs a partial gastrectomy with a gastrojejunostomy in a patient with a gastric outlet obstruction.
6. A patient with early-stage stomach cancer undergoes a partial gastrectomy with a gastrojejunostomy as part of their treatment plan.
7. A surgeon performs a partial gastrectomy with a gastrojejunostomy in a patient with a large gastric mass that is causing significant symptoms.
8. A patient with a history of gastric adenocarcinoma undergoes a partial gastrectomy with a gastrojejunostomy for disease recurrence.