How To Use CPT Code 43635

CPT 43635 describes the procedure of vagotomy when performed with partial distal gastrectomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43635?

CPT 43635 is used to describe the surgical procedure of vagotomy when performed with partial distal gastrectomy. This code is used when the provider transects the vagus nerve and removes the distal part of the stomach. It is important to note that CPT 43635 should be used in conjunction with other codes for the primary procedure, such as 43631, 43632, 43633, and 43634.

2. Official Description

The official description of CPT code 43635 is: ‘Vagotomy when performed with partial distal gastrectomy (List separately in addition to code[s] for primary procedure).’ It is important to use this code in conjunction with the appropriate primary procedure codes.

3. Procedure

1. The provider begins the procedure by making an incision through an avascular area to reach the lesser sac.
2. The dissection starts with the anterior vagus nerve in the lesser omentum, and all the gastric branches are ligated and divided one by one.
3. For posterior selective vagotomy, the provider makes an incision through the peritoneum and carefully dissects, ligates, and divides the tissues.
4. The provider then makes a right paramedian incision to explore the stomach and splits the transverse mesocolon vertically through an avascular area to enter the lesser sac.
5. The posterior wall of the stomach is drawn out through the split of the mesocolon, and Allis tissue forceps are applied to the fold to prevent bleeding or secretions from disturbing the anastomosis.
6. A hand is passed along the undersurface of the transverse mesocolon to locate the duodenojejunal flexure and the first loop of the jejunum.
7. The jejunum is placed by the side of the posterior wall of the stomach to form an isoperistaltic anastomosis.

4. Qualifying circumstances

CPT 43635 is performed in cases of uncomplicated duodenal ulcer, where vagotomy is often performed along with partial distal gastrectomy. The procedure involves transecting the vagus nerve and removing the distal part of the stomach. It is important to note that CPT 43635 should be used in conjunction with other codes for the primary procedure.

5. When to use CPT code 43635

CPT code 43635 should be used when the provider performs vagotomy along with partial distal gastrectomy. It is important to use this code in addition to the appropriate primary procedure codes. If the notes do not mention directly or indirectly that a distal gastrectomy was performed, the coder should ask the surgeon to revise the note before submitting the claim.

6. Documentation requirements

To support a claim for CPT 43635, the provider must document the following information:

• Indication for the procedure, such as uncomplicated duodenal ulcer
• Details of the vagotomy and partial distal gastrectomy performed
• Specific incisions made and dissection techniques used
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43635, ensure that the procedure is performed in conjunction with the appropriate primary procedure codes. CPT 43635 is an add-on code and should not be further reduced in value when reported with partial distal gastrectomy. It should be paid at 100 percent of the carrier’s approved amounts. It is important to follow the guidelines of the specific payer when reporting this code.

8. Historical information

CPT 43635 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition. However, it is important to stay updated with any changes or revisions made by the American Medical Association (AMA) and the payer guidelines.

9. Examples

1. A surgeon performs vagotomy when performed with partial distal gastrectomy for a patient with an uncomplicated duodenal ulcer.
2. A gastroenterologist performs vagotomy when performed with partial distal gastrectomy for a patient with recurrent gastric ulcers.
3. A general surgeon performs vagotomy when performed with partial distal gastrectomy for a patient with gastric cancer.
4. A surgical team performs vagotomy when performed with partial distal gastrectomy for a patient with gastrointestinal bleeding.
5. An oncologist performs vagotomy when performed with partial distal gastrectomy for a patient with a malignant tumor in the stomach.
6. A bariatric surgeon performs vagotomy when performed with partial distal gastrectomy as part of a weight loss surgery procedure.
7. A gastrointestinal surgeon performs vagotomy when performed with partial distal gastrectomy for a patient with a perforated gastric ulcer.
8. A surgical team performs vagotomy when performed with partial distal gastrectomy for a patient with a gastric outlet obstruction.
9. An experienced surgeon performs vagotomy when performed with partial distal gastrectomy for a patient with a complicated duodenal ulcer.
10. A multidisciplinary surgical team performs vagotomy when performed with partial distal gastrectomy for a patient with a rare gastrointestinal disorder.