How To Use CPT Code 43865

CPT 43865 describes the revision of a gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection, including vagotomy. 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 43865?

CPT 43865 is used to describe the revision of a previously created anastomosis between the stomach and jejunum. This procedure may also involve partial gastrectomy or intestine resection, and includes vagotomy. The purpose of this revision is to alleviate symptoms caused by scarring and adhesions resulting from the previous procedure or disease progression. It is typically performed to relieve obstruction, pain, or other complications associated with the previous anastomosis.

2. Official Description

The official description of CPT code 43865 is: ‘Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy.’

3. Procedure

1. The provider begins by making an incision in the upper midline of the abdomen, extending it if necessary for better exposure.
2. After entering the abdomen, any adhesions are carefully removed to ensure good visualization of the surgical site.
3. The provider examines the previous anastomosis site, excising any scar tissue and removing any staples or materials used in the initial procedure.
4. If necessary, the provider may perform a partial gastrectomy or intestine resection to address disease or improve the anastomosis.
5. A new anastomosis is then created between the stomach and jejunum using either staples or sutures.
6. The provider identifies and isolates the vagus nerve, and may transect it with a scalpel or scissors as part of the vagotomy.
7. After ensuring there is no bleeding and removing any instruments, the provider closes the abdominal incision in layers.

4. Qualifying circumstances

CPT 43865 is performed on patients who require a revision of a gastrojejunal anastomosis. This procedure is typically indicated when there are symptoms such as obstruction, pain, or complications resulting from scarring and adhesions. The revision may involve partial gastrectomy or intestine resection, and includes vagotomy. It is important to note that this procedure should only be performed by a qualified healthcare professional with the necessary expertise and training.

5. When to use CPT code 43865

CPT code 43865 should be used when a revision of a gastrojejunal anastomosis is performed, with or without partial gastrectomy or intestine resection, including vagotomy. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the procedure does not meet these criteria, an alternative code should be used to accurately report the service provided.

6. Documentation requirements

To support a claim for CPT code 43865, the healthcare provider must document the following information:

• Reason for the revision of the gastrojejunal anastomosis
• Details of any partial gastrectomy or intestine resection performed
• Description of the vagotomy procedure
• Date of the procedure
• Any complications encountered during the procedure
• Any additional procedures performed during the same operative session
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 43865, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The procedure should be performed by a qualified healthcare professional with the necessary expertise and training. It is also important to follow any additional guidelines provided by the payer or relevant coding guidelines. It is recommended to review the complete documentation and coding guidelines to accurately report the service provided.

8. Historical information

CPT code 43865 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. However, it is important to stay updated with any changes or revisions to the coding guidelines and documentation requirements.

9. Examples

1. A patient undergoes a revision of a gastrojejunal anastomosis with reconstruction, including vagotomy, to alleviate symptoms of obstruction and pain resulting from scarring and adhesions.
2. A healthcare provider performs a revision of a gastrojejunal anastomosis with partial gastrectomy and vagotomy to address complications and improve the anastomosis.
3. A patient requires a revision of a gastrojejunal anastomosis with intestine resection and vagotomy due to disease progression and worsening symptoms.
4. A healthcare professional performs a revision of a gastrojejunal anastomosis with reconstruction and vagotomy to relieve symptoms of obstruction and pain caused by scarring and adhesions.
5. A patient undergoes a revision of a gastrojejunal anastomosis with partial gastrectomy, intestine resection, and vagotomy to address complications and improve their overall condition.