How To Use CPT Code 43653

CPT 43653 describes a laparoscopic surgical procedure known as gastrostomy, which involves the placement of a gastric tube without the construction of a gastric tube. This article will provide an overview of CPT code 43653, 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 43653?

CPT 43653 is a code used to describe a laparoscopic surgical procedure called gastrostomy. This procedure involves the placement of a gastric tube directly into the stomach cavity, allowing for direct access to the stomach for feeding or emptying the upper gastrointestinal tract. Unlike other gastrostomy procedures, CPT 43653 does not involve the construction of a gastric tube. Instead, it focuses solely on the placement of the tube.

2. Official Description

The official description of CPT code 43653 is: ‘Laparoscopy, surgical; gastrostomy, without construction of gastric tube (e.g., Stamm procedure) (separate procedure).’ This code specifically refers to the laparoscopic placement of a gastric tube without the creation of a gastric tube, such as in the Stamm procedure.

3. Procedure

1. The laparoscopic gastrostomy procedure begins with the patient being appropriately prepped and anesthetized.
2. The surgeon makes several small incisions in the abdomen to gain access to the stomach.
3. A small puncture is made through the abdomen and then through the stomach wall.
4. A large catheter is inserted into the stomach cavity through the puncture site.
5. The surgeon places one or two silk sutures to invert the stomach wall around the tube, creating an exterior lining for the tube tract.
6. The surgeon ensures that there is no bleeding inside the stomach and brings the tube out through a stab wound in the left upper quadrant of the abdomen.
7. The stomach is firmly sutured to the abdominal wall to secure the tube in place.
8. Sufficient sutures are placed around the exit site of the tube to prevent retraction, accidental displacement, and leakage.
9. A tube for gravity drainage is inserted.
10. The surgeon checks for bleeding, deflates the abdomen, removes any instruments, and closes the incisions in the abdomen with staples or sutures.

4. Qualifying circumstances

CPT 43653 is typically performed on patients who require direct access to the stomach for feeding or emptying the upper gastrointestinal tract. This procedure is commonly used when other methods of feeding or emptying the stomach are not feasible or effective. It is important to note that CPT 43653 specifically refers to the laparoscopic placement of a gastric tube without the construction of a gastric tube, such as in the Stamm procedure.

5. When to use CPT code 43653

CPT code 43653 should be used when a laparoscopic gastrostomy procedure is performed without the construction of a gastric tube. This code is appropriate when the surgeon places a gastric tube directly into the stomach cavity using laparoscopic techniques. It is important to ensure that the procedure performed aligns with the specific description of CPT 43653 and does not involve the construction of a gastric tube.

6. Documentation requirements

To support a claim for CPT 43653, the surgeon must document the following information:

• Patient’s diagnosis and the need for a gastrostomy procedure
• Details of the laparoscopic technique used
• Date of the procedure
• Specific steps taken during the procedure, including the placement of the gastric tube
• Any complications or additional procedures performed
• Signature of the surgeon performing the procedure

7. Billing guidelines

When billing for CPT 43653, it is important to ensure that the procedure performed aligns with the specific description of the code. This code should only be reported when a laparoscopic gastrostomy procedure without the construction of a gastric tube is performed. It should not be reported if other laparoscopic procedures, such as gastric bypass or bowel resection, are performed at the same time. It is crucial to review the documentation and accurately report the appropriate code based on the specific procedure performed.

8. Historical information

CPT code 43653 was added to the Current Procedural Terminology system on January 1, 2000. Since its addition, there have been no updates or changes to the code.

9. Examples

1. A laparoscopic gastrostomy procedure is performed on a patient with a neurological condition that impairs their ability to swallow and requires direct access to the stomach for feeding.
2. A laparoscopic gastrostomy procedure is performed on a patient with a severe gastrointestinal disorder that necessitates direct access to the stomach for emptying the upper gastrointestinal tract.
3. A laparoscopic gastrostomy procedure is performed on a patient with a congenital anomaly that affects their ability to digest food and requires direct access to the stomach for feeding.
4. A laparoscopic gastrostomy procedure is performed on a patient with a progressive neurological disease that impairs their ability to swallow and necessitates direct access to the stomach for feeding.
5. A laparoscopic gastrostomy procedure is performed on a patient with a severe swallowing disorder that requires direct access to the stomach for feeding.
6. A laparoscopic gastrostomy procedure is performed on a patient with a chronic illness that affects their ability to eat and necessitates direct access to the stomach for feeding.