How To Use CPT Code 43830

CPT 43830 describes the placement of a gastric tube for direct access to the stomach cavity, allowing for feeding or emptying of the upper gastrointestinal tract. 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 43830?

CPT 43830 involves the surgical placement of a gastric tube to provide direct access to the stomach cavity. This procedure is performed when patients require feeding or the emptying of their upper gastrointestinal tract through the stomach. It is important to note that CPT 43830 does not involve the construction of a gastric tube, such as the Stamm procedure.

2. Official Description

The official description of CPT code 43830 is: ‘Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure) (separate procedure).’ This code specifically refers to the placement of a gastric tube without the creation of a gastric tube, such as the Stamm procedure.

3. Procedure

1. During the procedure, the provider selects a suitable point on the middle anterior surface of the stomach, ensuring that there is no tension.
2. An incision is made in the abdomen, followed by a small puncture in the stomach wall.
3. A large catheter is inserted approximately 1 to 2 inches into the stomach cavity.
4. Sutures are placed to invert the stomach wall around the tube, creating an exterior lining for the tube tract.
5. The provider ensures there is no bleeding inside the stomach.
6. The tube is brought out through a stab wound in the left upper quadrant of the abdomen, and the stomach is firmly attached to the abdominal wall.
7. Sufficient sutures are placed around the exit site of the tube to prevent retraction, accidental dislocation, and leakage.
8. A tube is inserted for gravity drainage.

4. Qualifying circumstances

CPT 43830 is performed on patients who require direct access to the stomach cavity for feeding or emptying of the upper gastrointestinal tract. It is typically used when other methods of tube placement, such as endoscopic or laparoscopic procedures, are not feasible. The procedure is performed under appropriate anesthesia, and the patient must be properly prepped for the surgery.

5. When to use CPT code 43830

CPT code 43830 should be used when a provider performs an open gastrostomy procedure without the construction of a gastric tube, such as the Stamm procedure. It is important to note that this code should not be reported separately if the open placement of the gastrostomy tube occurs on the same day as another procedure in the upper abdominal or stomach area.

6. Documentation requirements

To support a claim for CPT 43830, the provider must document the following information:

• Reason for the procedure and the need for direct access to the stomach cavity
• Details of the surgical technique used, including the location of the incision and puncture
• Description of the tube placement and any sutures used
• Confirmation of no bleeding inside the stomach
• Documentation of the attachment of the stomach to the abdominal wall
• Details of the tube placement for gravity drainage
• Signature of the performing provider

7. Billing guidelines

When billing for CPT 43830, it is important to ensure that the procedure is performed as a separate procedure and not in conjunction with other upper abdominal or stomach procedures on the same day. The National Correct Coding Initiative bundles CPT 43830 with certain codes, such as 43101, which involves the excision of a lesion in the esophagus with primary repair. Therefore, it is crucial to review the bundling guidelines and report the appropriate codes accordingly.

8. Historical information

CPT code 43830 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with dysphagia requires the placement of a gastric tube for direct access to the stomach cavity to ensure proper nutrition.
2. An individual with gastric outlet obstruction needs a gastric tube for the direct emptying of the upper gastrointestinal tract through the stomach.
3. A patient with severe reflux disease requires a gastric tube for the direct emptying of the stomach to alleviate symptoms.
4. An individual with a neurological disorder needs a gastric tube for direct feeding due to difficulty swallowing.
5. A patient with a history of esophageal cancer requires a gastric tube for direct access to the stomach cavity for nutritional support.
6. An individual with a severe gastrointestinal motility disorder needs a gastric tube for direct feeding to maintain adequate nutrition.
7. A patient with a traumatic injury to the upper gastrointestinal tract requires a gastric tube for direct access to the stomach cavity for proper healing.
8. An individual with a congenital anomaly affecting the upper gastrointestinal tract needs a gastric tube for direct feeding.
9. A patient with a chronic illness requiring long-term enteral feeding requires a gastric tube for direct access to the stomach cavity.
10. An individual with a history of gastric surgery needs a gastric tube for direct access to the stomach cavity for nutritional support.