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A partial gastrectomy, specifically a distal gastrectomy, is a surgical procedure aimed at removing the lower portion of the stomach. This operation is typically indicated for various gastrointestinal conditions that necessitate the removal of part of the stomach to alleviate symptoms or improve function. During the procedure, a surgical incision is made in the abdomen to access the stomach. The surgeon carefully divides the stomach at the pylorus, which is the opening from the stomach into the small intestine, allowing for the mobilization of the stomach to expose critical blood vessels, particularly the left gastric artery. This artery is essential for supplying blood to the stomach, and its branches are meticulously identified, divided, and ligated to prevent excessive bleeding during the surgery. Once the stomach is adequately prepared, its contents are evacuated, and the organ is decompressed to facilitate the surgical process. The surgeon then marks the sites for resection, ensuring precise cuts are made to remove the distal portion of the stomach. After the stomach is divided, a staple line is applied to secure the remaining stomach tissue, which is then oversewn with sutures to ensure hemostasis, or the cessation of bleeding. Following the resection, the remaining stomach segment is aligned with a segment of the jejunum, which is part of the small intestine. This alignment is crucial for the subsequent anastomosis, where the two segments are joined together. Temporary stay sutures are initially placed to hold the structures in position before being replaced with running sutures that secure the stomach serosa to the intestinal serosa. This procedure is particularly important as it establishes a new pathway for food to pass from the stomach into the small intestine, thereby maintaining digestive function after the partial gastrectomy. The specific code for this procedure is CPT® 43632, which is used when the stomach is anastomosed to the jejunum, distinguishing it from other related procedures that involve different anatomical connections.
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The partial distal gastrectomy with gastrojejunostomy is indicated for various gastrointestinal conditions that may include:
The procedure begins with the patient under general anesthesia, followed by a surgical incision in the abdomen to access the stomach. The surgeon exposes the stomach and carefully divides it at the pylorus, allowing for mobilization of the stomach to visualize the left gastric artery. Once the artery is identified, the vascular pedicle is clamped to control blood flow, and the stomach contents are evacuated to facilitate the surgical steps. The surgeon then decompresses the stomach and identifies the branches of the left gastric artery, which are divided and ligated distal to the clamp to ensure hemostasis. Next, the proximal resection site is marked with a suture, and the distal point of resection is identified using non-crushing clamps. The stomach is then divided, and a staple line is applied to secure the remaining stomach tissue. This staple line is oversewn with sutures to further ensure that there is no bleeding from the resection site. Following the resection, the remaining stomach segment is aligned with a selected segment of the jejunum. Temporary stay sutures are placed to hold the two segments in position. These temporary sutures are subsequently replaced with running sutures that approximate the serosa of the stomach to the serosa of the jejunum, completing the anastomosis. This connection allows for the passage of food from the stomach into the jejunum, establishing a new route for digestion. The procedure is coded as CPT® 43632 when the stomach is anastomosed to the jejunum, differentiating it from other related procedures.
After the completion of the partial distal gastrectomy with gastrojejunostomy, the patient is typically monitored in a recovery area until the effects of anesthesia wear off. Post-operative care includes managing pain, monitoring for any signs of complications such as infection or bleeding, and ensuring that the patient is stable. Patients may initially be placed on a restricted diet, gradually progressing to a regular diet as tolerated. Follow-up appointments are essential to assess recovery and to monitor for any potential nutritional deficiencies or complications related to the surgery. The overall recovery time can vary based on the individual patient's health status and adherence to post-operative care instructions.
| Short Descr | REMOVAL OF STOMACH PARTIAL | Medium Descr | GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY | Long Descr | Gastrectomy, partial, distal; with gastrojejunostomy | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 74 - Gastrectomy, partial and total |
This is a primary code that can be used with these additional add-on codes.
| 43635 | Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Vagotomy when performed with partial distal gastrectomy (List separately in addition to code[s] for primary procedure) | 96547 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure) | 96548 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 81 | Minimum assistant surgeon: minimum surgical assistant services are identified by adding modifier 81 to the usual procedure number. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | AG | Primary physician | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | ET | Emergency services | GC | This service has been performed in part by a resident under the direction of a teaching physician | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | RT | Right side (used to identify procedures performed on the right side of the body) | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2011-01-01 | Changed | Short description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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