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A laparoscopic surgical procedure known as transection of the vagus nerves, or truncal vagotomy, involves the cutting of the vagus nerve, which is the tenth cranial nerve. This nerve originates from the brainstem and extends through the neck, thorax, and abdomen, branching out to innervate various parts of the stomach and upper digestive tract. The primary purpose of performing a vagotomy is to reduce excessive acid production in the stomach, thereby helping to prevent the formation of peptic ulcers. Although vagotomy was once a common surgical intervention for ulcer treatment, its frequency has diminished significantly due to the effectiveness of pharmacological therapies available today. During the procedure, a small incision is made in the upper abdomen, through which a trocar is inserted to establish pneumoperitoneum, allowing for the introduction of a laparoscope. Additional incisions are made to facilitate the use of surgical instruments. The vagus nerve is carefully identified and separated from surrounding tissues. In the context of CPT® Code 43651, a truncal vagotomy is specifically performed, which involves the division of the main vagal trunks. This contrasts with selective or highly selective vagotomy procedures, which target specific branches of the vagus nerve. After the surgical intervention is completed, all instruments and the laparoscope are removed, air is released from the abdominal cavity, and the incisions are closed to complete the process.
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The procedure of truncal vagotomy, as described by CPT® Code 43651, is indicated for the following conditions:
The procedure for truncal vagotomy involves several critical steps, which are outlined as follows:
Post-procedure care following truncal vagotomy typically involves monitoring the patient for any complications related to the surgery. Patients may experience changes in gastric function due to the alteration of nerve pathways, which can affect digestion and acid production. Recovery may include dietary modifications and follow-up appointments to assess healing and manage any potential side effects. It is essential for healthcare providers to provide clear instructions regarding post-operative care and to monitor the patient’s recovery closely.
| Short Descr | LAPAROSCOPY VAGUS NERVE | Medium Descr | LAPS SURG TRNSXJ VAGUS NRV TRUNCAL | Long Descr | Laparoscopy, surgical; transection of vagus nerves, truncal | 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 94 - Other OR upper GI therapeutic procedures |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 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). | 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. | 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 | 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. |
| 2000-01-01 | Added | First appearance in code book in 2000. |
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