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The procedure described by CPT® Code 43635 involves a surgical intervention known as vagotomy, which is performed in conjunction with a partial distal gastrectomy. The vagus nerve, identified as the tenth cranial nerve, plays a crucial role in the autonomic regulation of the gastrointestinal tract. It originates from the brainstem and extends through the neck, thorax, and abdomen, branching out to innervate various parts of the stomach and upper digestive system. The primary purpose of performing a vagotomy is to reduce the production of gastric acid, which can help in the prevention of peptic ulcers. Historically, vagotomy was a common surgical approach for managing ulcers; however, its frequency has diminished significantly due to the effectiveness of pharmacological treatments available today. During the procedure, the vagus nerve is carefully identified and separated from adjacent structures, followed by the division of the main vagal nerve trunks to achieve the desired therapeutic effect.
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The vagotomy procedure, as described by CPT® Code 43635, is indicated for specific conditions related to excessive gastric acid production. The following are the primary indications for performing this procedure:
The surgical procedure for vagotomy when performed with a partial distal gastrectomy involves several critical steps, which are outlined as follows:
Post-procedure care following vagotomy with partial distal gastrectomy includes monitoring the patient for any complications such as infection, bleeding, or issues related to gastric emptying. Patients may require a modified diet initially, transitioning from liquids to soft foods as tolerated. It is essential to provide education on potential changes in digestion and the importance of follow-up appointments to assess recovery and manage any long-term effects of the surgery.
| Short Descr | REMOVAL OF STOMACH PARTIAL | Medium Descr | VAGOTOMY PFRMD W/PRTL DSTL GSTRCT | Long Descr | Vagotomy when performed with partial distal gastrectomy (List separately in addition to code[s] for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No 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 | 94 - Other OR upper GI therapeutic procedures |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 43631 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Gastrectomy, partial, distal; with gastroduodenostomy | 43632 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Gastrectomy, partial, distal; with gastrojejunostomy | 43633 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Gastrectomy, partial, distal; with Roux-en-Y reconstruction | 43634 | MPFS Status: Active Code APC C Physician Quality Reporting CPT Assistant Article Illustration for Code Gastrectomy, partial, distal; with formation of intestinal pouch |
| 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). | 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. | 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.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 |
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Notes
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| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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