How To Use CPT Code 43641

CPT 43641 describes a surgical procedure known as vagotomy, which involves the selective removal of parietal cells in the stomach. This article will provide an overview of CPT code 43641, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and similar codes.

1. What is CPT Code 43641?

CPT 43641 is a code used to describe a surgical procedure called vagotomy. This procedure involves the removal of parietal cells in the stomach, which can help increase the diameter of the pylorus. It may also involve the creation of an opening in the stomach known as a gastrostomy. Vagotomy is typically performed to treat certain conditions, such as pyloric stenosis in infants.

2. Official Description

The official description of CPT code 43641 is: ‘Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell (highly selective).’ This code specifically refers to the removal of parietal cells in the stomach, which is a highly selective form of vagotomy. It may also include pyloroplasty, a procedure to widen the opening in the lower part of the stomach.

3. Procedure

1. The surgeon makes an incision in the abdomen and reaches the lesser sac by dissecting through the avascular area.
2. The anterior vagus nerve in the lesser omentum is identified, ligated, and divided.
3. The gastric branches are ligated and divided one by one.
4. For a posterior selective vagotomy, the peritoneum is incised at an angle to reach the posterior trunk, which is carefully ligated and divided.
5. The nerves of Latarjet, which supply the antrum and pylorus, are preserved by passing forceps through the lesser curvature.
6. An incision is made in the pyloric canal, and the upper and lower edges of the incision are pulled apart to widen the pyloric canal.
7. The defect is closed using sutures.

4. Qualifying circumstances

CPT code 43641 is typically performed on patients with specific conditions, such as pyloric stenosis in infants. It is important to note that this code specifically refers to the highly selective removal of parietal cells in the stomach. The procedure may also involve pyloroplasty and, in some cases, gastrostomy. The decision to perform vagotomy and the specific circumstances may vary depending on the patient’s condition and the surgeon’s judgment.

5. When to use CPT code 43641

CPT code 43641 should be used when a surgeon performs a highly selective vagotomy, specifically targeting the parietal cells in the stomach. This code may also be used when pyloroplasty is performed, with or without gastrostomy. It is important to accurately document the details of the procedure to support the use of this code.

6. Documentation requirements

When reporting CPT code 43641, the following documentation is typically required:

• Details of the procedure performed, including the removal of parietal cells, pyloroplasty, and gastrostomy if applicable
• Incision site and approach used
• Specific anatomical structures targeted and manipulated during the procedure
• Any additional procedures performed in conjunction with vagotomy
• Any complications or unexpected findings during the procedure
• Post-operative care instructions, if applicable

7. Billing guidelines

When billing for CPT code 43641, it is important to ensure that the procedure performed aligns with the code’s description. The surgeon should clearly document the removal of parietal cells, pyloroplasty, and gastrostomy if applicable. It is also important to follow any specific billing guidelines provided by the payer or coding guidelines. Additionally, it is essential to accurately report any other procedures performed in conjunction with vagotomy.

8. Historical information

CPT code 43641 was added to the Current Procedural Terminology system on January 1, 1990. Since its addition, there have been no updates or changes to the code.

9. Examples

1. A surgeon performs a highly selective vagotomy, removing parietal cells in the stomach, and also performs pyloroplasty for a patient with pyloric stenosis.
2. During a surgical procedure, a surgeon performs a highly selective vagotomy and also creates a gastrostomy opening in the stomach for a patient with a specific medical condition.
3. A surgeon performs a highly selective vagotomy and pyloroplasty to widen the pyloric canal for a patient with a specific gastrointestinal disorder.
4. For a patient with a particular condition, a surgeon performs a highly selective vagotomy and also performs gastrostomy to create an opening in the stomach.
5. A surgeon performs a highly selective vagotomy and pyloroplasty, without gastrostomy, for a patient with a specific medical condition.
6. During a surgical procedure, a surgeon performs a highly selective vagotomy and also performs gastrostomy to create an opening in the stomach for a patient with a specific condition.
7. A surgeon performs a highly selective vagotomy and pyloroplasty to widen the pyloric canal for a patient with a specific gastrointestinal disorder.
8. For a patient with a particular condition, a surgeon performs a highly selective vagotomy and also performs gastrostomy to create an opening in the stomach.
9. A surgeon performs a highly selective vagotomy and pyloroplasty, without gastrostomy, for a patient with a specific medical condition.
10. During a surgical procedure, a surgeon performs a highly selective vagotomy and also performs gastrostomy to create an opening in the stomach for a patient with a specific condition.