How To Use CPT Code 43640

CPT 43640 describes a surgical procedure known as vagotomy, which involves the transection of both trunks of the vagus nerve and the repair of the pylorus to widen the pyloric opening. This article will provide an overview of CPT code 43640, including its official description, the procedure involved, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes.

1. What is CPT Code 43640?

CPT 43640 is a code used to describe a surgical procedure called vagotomy, which includes the transection of both trunks of the vagus nerve and the repair of the pylorus to increase the caliber of the pyloric opening. This procedure is performed to improve the passage of stomach contents into the small intestine.

2. Official Description

The official description of CPT code 43640 is: ‘Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective.’ It is important to note that for pyloroplasty alone, the appropriate code to use is 43800. Additionally, for vagotomy alone, refer to codes 64755 and 64760.

3. Procedure

1. The surgeon makes an incision, either midline or left paramedian, and carefully incises the peritoneum over the abdominal part of the esophagus.
2. The lowest 3 inches of the esophagus are mobilized and retracted downwards, allowing visualization of the anterior trunk of the vagus nerve on the anterior surface of the esophagus and the posterior trunk away from the esophagus.
3. The surgeon cuts 5 to 7 cm of both trunks of the vagus nerve and ties the remaining ends with fine silk.
4. A ligature is placed to prevent bleeding from the ascending esophageal vessels.
5. The surgeon then makes an incision through all layers of the pyloric canal, starting from 3.5 cm proximal to the pylorus and extending up to 2.5 cm distal on the anterior wall of the duodenum.
6. The defect or ulcer, if present, is excised along with the incision.
7. The upper and lower edges of the incision are pulled apart to widen the pyloric canal, and the defect is closed with sutures.

4. Qualifying circumstances

CPT 43640 is performed on patients who require a vagotomy and pyloroplasty to address conditions such as pyloric stenosis. It is important to note that for vagotomy requiring pyloromyotomy without gastrectomy, use code 43640. For highly selective parietal cell vagotomy, use code 43641.

5. When to use CPT code 43640

CPT code 43640 should be used when a vagotomy, including pyloroplasty, is performed to widen the pyloric opening. It is important to ensure that the procedure meets the specific criteria outlined in the official description of the code.

6. Documentation requirements

To support a claim for CPT code 43640, the surgeon must document the following information:

• Patient’s diagnosis and the need for vagotomy and pyloroplasty
• Details of the surgical procedure performed, including the incision type, transection of the vagus nerve, repair of the pylorus, and any additional procedures
• 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 43640, ensure that the procedure meets the specific criteria outlined in the official description. It is important to follow the appropriate coding guidelines and modifiers, if applicable. Additionally, consider any Medicare changes or specific billing requirements that may apply.

8. Historical information

CPT code 43640 was added to the Current Procedural Terminology system on January 1, 1990. It is important to note that there have been no updates to the code since its addition. However, it is always recommended to stay updated with any changes or revisions to the coding guidelines.

9. Examples

1. A surgeon performs vagotomy including pyloroplasty on a patient with pyloric stenosis to widen the pyloric opening and improve the passage of stomach contents into the small intestine.
2. During a surgical procedure, a surgeon transects both trunks of the vagus nerve and repairs the pylorus to increase the caliber of the pyloric opening for a patient with gastroparesis.
3. A patient with peptic ulcer disease undergoes vagotomy including pyloroplasty to alleviate symptoms and improve gastric emptying.
4. A surgeon performs vagotomy including pyloroplasty on a patient with recurrent gastric ulcers to prevent further ulcer formation and improve digestion.
5. During a surgical procedure, a surgeon performs vagotomy including pyloroplasty to address pyloric stenosis in an infant.
6. A patient with gastric outlet obstruction undergoes vagotomy including pyloroplasty to relieve the obstruction and improve gastric emptying.
7. A surgeon performs vagotomy including pyloroplasty on a patient with refractory gastroparesis to enhance gastric emptying and alleviate symptoms.
8. During a surgical procedure, a surgeon transects both trunks of the vagus nerve and repairs the pylorus to widen the pyloric opening for a patient with gastric cancer.
9. A patient with chronic peptic ulcer disease undergoes vagotomy including pyloroplasty to promote healing and prevent ulcer recurrence.
10. A surgeon performs vagotomy including pyloroplasty on a patient with intractable gastric ulcers to improve symptoms and prevent further ulcer formation.