How To Use CPT Code 43860

CPT 43860 describes the revision and reconstruction of a previously created anastomosis between the stomach and jejunum. 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 43860?

CPT 43860 can be used to describe the revision and reconstruction of a previous anastomosis between the stomach and jejunum. This code is used when the provider performs a procedure to relieve obstruction, pain, or other symptoms caused by scarring and adhesions resulting from the previous anastomosis or progression of the disease for which the previous procedure was performed.

2. Official Description

The official description of CPT code 43860 is: ‘Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy.’

3. Procedure

1. The provider begins by making an incision in the upper midline of the abdomen and may extend it past the umbilicus for better exposure.
2. After entering the abdomen, the provider ensures good visualization of the cavity and takes down any adhesions.
3. The site of the previous anastomosis is examined, scar tissue is excised, and any staples or materials used in the previous anastomosis are removed.
4. The provider isolates and inspects the stomach and intestines, and may perform a partial gastrectomy if necessary.
5. A new anastomosis is constructed using staples or sutures to connect the stomach to the jejunum.
6. Bleeding is checked, instruments are removed, and the abdominal incision is closed in layers.

4. Qualifying circumstances

Patients eligible for CPT 43860 are those who have previously undergone a gastrojejunal anastomosis and require revision and reconstruction due to obstruction, pain, or other symptoms caused by scarring and adhesions. The procedure may also involve a partial gastrectomy or intestine resection. Vagotomy is not performed during this procedure.

5. When to use CPT code 43860

CPT code 43860 should be used when the provider performs a revision and reconstruction of a previous gastrojejunal anastomosis without vagotomy. It is important to accurately document the medical necessity for this procedure and ensure that it is not reported with other codes that may already include the excision of scar tissue and takedown of adhesions.

6. Documentation requirements

To support a claim for CPT 43860, the provider must document the following information:

• Patient’s diagnosis and the medical necessity for the revision and reconstruction
• Details of the previous anastomosis and any complications or symptoms caused by scarring and adhesions
• Description of the procedure performed, including any partial gastrectomy or intestine resection
• Date of the procedure and the duration of the surgery
• Any additional work performed that is unrelated to the previous procedure, if applicable
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 43860, ensure that the procedure meets the criteria for revision and reconstruction of a previous gastrojejunal anastomosis without vagotomy. It is important to accurately assign the appropriate CPT code and modifiers, if applicable, to describe any additional work performed. Modifier 22 may be used if the operative report describes extensive work unrelated to the previous procedure. However, modifier 22 should not be used to describe the excision of scar tissue and takedown of adhesions, as they are included in the reimbursement for the procedure.

8. Historical information

CPT 43860 was added to the Current Procedural Terminology system on January 1, 1990. The code was revised on January 1, 2002 to clarify the description. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A patient undergoes revision and reconstruction of a previous gastrojejunal anastomosis without vagotomy to relieve obstruction caused by scarring and adhesions.
2. A provider performs CPT 43860 to address pain and other symptoms resulting from a previous anastomosis between the stomach and jejunum.
3. A partial gastrectomy is performed during the revision and reconstruction of a gastrojejunal anastomosis without vagotomy using CPT code 43860.
4. A patient requires CPT 43860 due to the progression of the disease for which the previous anastomosis was performed.
5. A provider performs CPT 43860 to improve the anastomosis between the stomach and jejunum and relieve symptoms caused by scarring and adhesions.
6. Revision and reconstruction of a previous gastrojejunal anastomosis without vagotomy is performed to address obstruction and pain using CPT code 43860.