How To Use CPT Code 43800

CPT 43800 describes the repair of the pylorus to increase the size of the pyloric opening by stretching. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43800?

CPT 43800 is used to explain the procedure of repairing the pylorus to widen the pyloric opening by stretching. This code is specifically for an open pyloroplasty, and it should not be used for laparoscopic pyloroplasty procedures. For laparoscopic pyloroplasty, the appropriate code to use is 43659, which is an unlisted laparoscopy procedure for the stomach.

2. Official Description

The official description of CPT code 43800 is the repair of the pylorus to increase the caliber of the pyloric opening by stretching. It is important to note that for pyloroplasty and vagotomy procedures, CPT code 43640 should be used instead.

3. Procedure

1. The physician makes an incision through all the 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.
2. All contents of the duodenum and stomach are aspirated, and the inner wall is inspected to locate any defects or ulcers.
3. If a defect or ulcer is close to the incision, it may be excised along with the incision.
4. The upper and lower edges of the incision are pulled apart with forceps to bring the proximal and distal ends of the incision closer together, widening the pyloric canal.
5. The defect is closed using sutures.

4. Qualifying circumstances

CPT 43800 is performed when there is a need to repair the pylorus and increase the size of the pyloric opening. This procedure is typically done for patients with specific conditions or complications related to the pylorus. It is important to note that CPT code 43800 should not be used for laparoscopic pyloroplasty procedures.

5. When to use CPT code 43800

CPT code 43800 should be used when performing an open pyloroplasty procedure to repair the pylorus and widen the pyloric opening. It is important to note that this code should not be used for laparoscopic pyloroplasty procedures, as there is no specific code available for that technique. In such cases, the unlisted procedure code 43659 should be used.

6. Documentation requirements

To support a claim for CPT code 43800, the following documentation should be included:

• Patient’s diagnosis and the need for pyloric repair
• Details of the procedure performed, including the incision location and size
• Confirmation of the defect or ulcer location and any excision performed
• Method used to widen the pyloric canal
• Details of the closure technique
• Any additional relevant information or complications encountered during the procedure

7. Billing guidelines

When billing for CPT code 43800, ensure that the procedure performed is an open pyloroplasty and not a laparoscopic pyloroplasty. If a laparoscopic pyloroplasty is performed, the appropriate code to use is 43659, which is an unlisted laparoscopy procedure for the stomach. It is important to provide thorough documentation and compare the procedure to the work involved in CPT code 43800 when reporting the unlisted procedure code to the payer.

8. Historical information

CPT code 43800 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. However, it is worth noting that in 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A surgeon performs an open pyloroplasty to repair the pylorus and widen the pyloric opening for a patient with pyloric stenosis.
2. A patient with a peptic ulcer undergoes an open pyloroplasty procedure to repair the pylorus and improve gastric emptying.
3. A physician performs an open pyloroplasty to treat a patient with gastroparesis and alleviate symptoms of delayed gastric emptying.
4. An individual with pyloric obstruction undergoes an open pyloroplasty to relieve the blockage and improve digestion.
5. A patient with pyloric scarring from previous surgery undergoes an open pyloroplasty to correct the narrowing and improve gastric emptying.
6. A surgeon performs an open pyloroplasty to repair the pylorus and alleviate symptoms of gastric outlet obstruction in a patient with stomach cancer.
7. An individual with pyloric stenosis due to chronic inflammation undergoes an open pyloroplasty to widen the pyloric opening and improve gastric emptying.
8. A patient with pyloric ulcers undergoes an open pyloroplasty to repair the pylorus and promote healing.
9. A surgeon performs an open pyloroplasty to treat a patient with pyloric dysfunction and improve gastric emptying.
10. An individual with pyloric stricture undergoes an open pyloroplasty to widen the pyloric opening and improve digestion.