How To Use CPT Code 43633

CPT 43633 describes a specific surgical procedure involving the removal of the lower part of the stomach and the reconstruction of the digestive system using a Roux-en-Y technique. This article will provide an overview of CPT code 43633, 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 43633?

CPT 43633 is a code used to describe a surgical procedure that involves the removal of the lower part of the stomach and the reconstruction of the digestive system using a Roux-en-Y technique. This procedure is typically performed to treat certain conditions or diseases affecting the stomach or the upper part of the small bowel.

2. Official Description

The official description of CPT code 43633 is: ‘Gastrectomy, partial, distal; with Roux-en-Y reconstruction.’

3. Procedure

1. The surgeon begins by mobilizing the stomach and the first part of the duodenum, which involves making an incision in the peritoneum on the lateral aspect of the duodenum.
2. The duodenum is then divided between clamps, just distal to the pylorus, and the distal cut end of the duodenum is covered with gauze and set aside for further anastomosis.
3. The distal cut end of the stomach and the duodenum are brought together without tension, and a seromuscular stitch is applied on the posterior walls of the two viscera to ensure they are in contact.
4. The continuity of the alimentary canal is maintained by anastomosing the distal divided part of the small bowel to the stomach, while the proximal end is anastomosed to the small bowel below the anastomosis.

4. Qualifying circumstances

CPT 43633 is typically performed on patients who have specific conditions or diseases that require the removal of the lower part of the stomach and the reconstruction of the digestive system. These conditions may include certain types of stomach cancer, gastric ulcers, or other disorders affecting the stomach or upper small bowel. The decision to perform this procedure is made by the surgeon based on the patient’s individual circumstances and medical history.

5. When to use CPT code 43633

CPT code 43633 should be used when a surgeon performs a partial gastrectomy with Roux-en-Y reconstruction. This code is appropriate when the specific procedure described in the official description is performed. 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 43633, the surgeon must document the following information:

• The reason for performing the procedure, including the patient’s diagnosis and the medical necessity of the surgery
• A detailed description of the procedure performed, including the specific techniques used and any modifications made
• The date of the surgery and the duration of the procedure
• Any additional procedures or services provided during the same operative session
• The surgeon’s signature and credentials

7. Billing guidelines

When billing for CPT code 43633, it is important to ensure that the procedure performed matches the description provided in the official documentation. This code should not be reported if a different procedure or technique was used. It is also important to follow any specific billing guidelines provided by the payer or insurance company to ensure accurate reimbursement.

8. Historical information

CPT code 43633 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 patient with gastric cancer undergoes a partial gastrectomy with Roux-en-Y reconstruction to remove the affected portion of the stomach and reconstruct the digestive system.
2. A patient with a gastric ulcer undergoes a partial gastrectomy with Roux-en-Y reconstruction to alleviate symptoms and promote healing.
3. A patient with a rare congenital disorder undergoes a partial gastrectomy with Roux-en-Y reconstruction to improve their ability to digest and absorb nutrients.
4. A patient with a history of gastric bypass surgery undergoes a partial gastrectomy with Roux-en-Y reconstruction to address complications or revision of the previous procedure.
5. A patient with a benign tumor in the lower part of the stomach undergoes a partial gastrectomy with Roux-en-Y reconstruction to remove the tumor and preserve the function of the digestive system.