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The procedure described by CPT® Code 43820 is known as gastrojejunostomy without vagotomy. This surgical intervention involves creating a connection between the stomach and the jejunum, which is part of the small intestine, without the need to remove any sections of the stomach, duodenum, or jejunum. The primary goal of this procedure is to facilitate the passage of food from the stomach into the jejunum, particularly in patients who may have conditions that obstruct normal gastric emptying or require bypassing certain areas of the gastrointestinal tract. Various surgical techniques can be employed during this procedure, including retrocolic and antecolic approaches, which refer to the positioning of the anastomosis relative to the colon. The operation typically begins with a midline incision in the abdomen to access the stomach and jejunum, followed by the mobilization of these organs and the careful dissection of any adhesions that may be present. The procedure is performed with precision to ensure that the connection between the stomach and jejunum is secure, allowing for effective digestion and nutrient absorption post-surgery. It is important to note that this specific code does not include vagotomy, which is a separate procedure that involves cutting the vagus nerve to reduce acid secretion in the stomach, often indicated for patients with peptic ulcer disease.
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The gastrojejunostomy procedure is indicated for patients experiencing specific gastrointestinal conditions that necessitate the bypass of the stomach or duodenum. These indications may include:
The gastrojejunostomy procedure involves several critical steps to ensure successful anastomosis between the stomach and jejunum. The procedure begins with a midline incision in the abdomen, allowing access to the abdominal cavity. Once opened, the stomach and jejunum are carefully exposed, and any adhesions that may hinder mobility are lysed. The surgeon then mobilizes the stomach and jejunum to facilitate the creation of the anastomosis. In the retrocolic technique, the stoma is positioned as close to the pylorus as possible, typically at the most dependent portion or greater curvature of the stomach. Clamps are applied along both the greater and lesser curvatures of the stomach to stabilize the area. The transverse colon is lifted, and the mesocolon is inspected to identify and protect the middle colic artery. An avascular segment of mesentery is then located and incised, allowing the stomach to protrude through the incision in the mesocolon, with the lesser curvature positioned at the lowest corner of the mesenteric opening. The lesser curvature is sutured to the mesocolon to secure the connection. A jejunal loop, located distal to the ligament of Treitz, is selected, clamped, and incised. The greater curvature of the stomach is also incised, and the jejunum is sutured to the opening in the stomach in a side-to-side fashion, completing the anastomosis. Alternatively, in the antecolic technique, the incision is made in the gastrocolic ligament instead of the mesocolon, and the anastomosis is performed using the same suturing technique. After the anastomosis is completed, the surgical wound is thoroughly irrigated, drains are placed as necessary, and the abdominal incision is closed in layers to promote proper healing.
Following the gastrojejunostomy procedure, patients typically require careful monitoring and post-operative care to ensure a smooth recovery. This may include management of pain, monitoring for signs of infection, and ensuring proper drainage from any placed drains. Patients are usually advised on dietary modifications to accommodate the changes in their digestive system, and gradual reintroduction of food is often recommended. The expected recovery period may vary based on individual health factors and the complexity of the surgery, but patients are generally encouraged to follow up with their healthcare provider to assess healing and address any complications that may arise.
| Short Descr | GASTROJEJUNOSTOMY WO VAGOTMY | Medium Descr | GASTROJEJUNOSTOMY W/O VAGOTOMY | Long Descr | Gastrojejunostomy; without vagotomy | 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 |
| GC | This service has been performed in part by a resident under the direction of a teaching physician | 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). | 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 | CR | Catastrophe/disaster related | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2025-01-01 | Changed | Short Description changed. |
| Pre-1990 | Added | Code added. |
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