How To Use CPT Code 43831

CPT 43831 describes a surgical procedure that involves creating a direct access to the lumen of the stomach for infants who need to be fed directly through the stomach. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43831?

CPT 43831 is a code used to describe a surgical procedure that creates a direct access to the lumen of the stomach for infants who require feeding directly through the stomach. This procedure is typically performed when other methods of feeding are not feasible or effective.

2. Official Description

The official description of CPT code 43831 is: ‘Gastrostomy, open; neonatal, for feeding.’ This code specifically refers to the surgical creation of an opening in the stomach for the insertion of a feeding tube in neonatal patients.

3. Procedure

1. The physician makes two incisions to access the stomach.
2. A tube with a balloon or mushroom-shaped bulb at one end is inserted into the stomach through the larger incision.
3. The other end of the tube is pulled through the second incision and secured.
4. The stomach is stitched to the abdominal wall to prevent the tube from falling out.

4. Qualifying circumstances

CPT 43831 is performed on neonatal patients who require direct feeding through the stomach. This procedure is typically reserved for cases where other methods of feeding, such as oral or nasogastric, are not feasible or effective. It is important to note that modifier 63 should not be reported in conjunction with CPT 43831.

5. When to use CPT code 43831

CPT code 43831 should be used when a neonatal patient requires a surgical gastrostomy for feeding purposes. It is important to ensure that other methods of feeding have been considered and deemed ineffective or unfeasible before opting for this procedure.

6. Documentation requirements

To support a claim for CPT 43831, the following documentation is required:

• Indication for the procedure and the need for direct feeding through the stomach
• Details of the surgical technique used
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the performing physician

7. Billing guidelines

When billing for CPT 43831, it is important to ensure that the procedure is performed on a neonatal patient for feeding purposes. Modifier 63 should not be reported in conjunction with this code. It is also important to follow any specific guidelines provided by the payer regarding documentation and billing for this procedure.

8. Historical information

CPT 43831 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 surgeon performs an open gastrostomy procedure on a neonatal patient who requires direct feeding through the stomach.
2. An infant with a congenital condition undergoes a surgical gastrostomy to facilitate feeding.
3. A premature baby with feeding difficulties receives a gastrostomy procedure to ensure adequate nutrition.
4. A neonatal patient with a medical condition that impairs oral feeding undergoes a surgical gastrostomy for feeding purposes.
5. An infant with a complex medical history requires a gastrostomy procedure to meet their nutritional needs.
6. A surgeon performs an open gastrostomy on a newborn with a gastrointestinal disorder that affects their ability to feed orally.
7. A neonatal patient with a congenital anomaly undergoes a gastrostomy procedure to enable direct feeding into the stomach.
8. An infant with a neurological condition receives a surgical gastrostomy to ensure proper nutrition.
9. A premature baby with a gastrointestinal disorder undergoes a gastrostomy procedure to facilitate feeding and growth.
10. A neonatal patient with a genetic disorder requires a surgical gastrostomy for long-term feeding support.