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The procedure described by CPT® Code 43640 involves a surgical intervention known as vagotomy, which is the cutting of the vagus nerve, specifically aimed at reducing excessive acid production in the stomach. The vagus nerve, the tenth cranial nerve, plays a crucial role in the autonomic regulation of the digestive system, influencing gastric secretions and motility. By performing a vagotomy, surgeons aim to alleviate conditions such as peptic ulcers that are exacerbated by high levels of stomach acid. The procedure can be categorized into truncal or selective vagotomy, depending on the extent of nerve division. A midline upper abdominal incision is utilized to access the stomach and the vagus nerve, allowing the surgeon to identify and isolate the nerve from surrounding tissues. In truncal vagotomy, the main trunks of the vagus nerve are severed, while in selective vagotomy, the procedure is more targeted, preserving certain branches that innervate the biliary tree. To mitigate the effects of vagotomy on gastric motility, a pyloroplasty is performed, which involves enlarging the opening between the stomach and the duodenum. Additionally, a gastrostomy may be performed to create an opening in the stomach for feeding purposes. This comprehensive approach addresses both the underlying issue of acid production and the functional implications of the surgery on gastric emptying.
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The procedure described by CPT® Code 43640 is indicated for the following conditions:
The procedure for CPT® Code 43640 involves several critical steps, which are detailed as follows:
After the completion of the procedure, patients are typically monitored for any immediate complications. Post-operative care may include pain management, monitoring for signs of infection, and ensuring proper gastric function. Patients may experience changes in gastric motility due to the vagotomy, and dietary modifications may be necessary to accommodate these changes. Follow-up appointments are essential to assess recovery and address any ongoing issues related to gastric emptying or nutritional needs.
| Short Descr | VAGOTOMY & PYLORUS REPAIR | Medium Descr | VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV | Long Descr | Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective | 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 | 94 - Other OR upper GI therapeutic procedures |
| 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). | 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.) | 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). | 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). | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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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| Pre-1990 | Added | Code added. |
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