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The procedure described by CPT® Code 43832 refers to an open gastrostomy with the construction of a gastric tube, specifically known as the Janeway procedure. This surgical intervention is performed to create an opening in the stomach that allows for the placement of a gastric tube, which is essential for providing nutrition directly to the stomach in patients who cannot eat by mouth. The procedure involves a series of meticulous steps, beginning with a small incision in the midline of the upper abdomen, which allows access to the abdominal cavity. The surgeon carefully incises the peritoneum and opens the abdominal cavity, addressing any adhesions that may be present. Once the stomach is accessed, the anterior aspect is grasped, and purse-string sutures are placed around the planned incision site. This technique is crucial for creating a secure opening in the stomach wall. The serosa is incised, and a portion of the inner mucosal layer is excised to facilitate the insertion of a balloon catheter. The catheter is then positioned within the stomach, and the balloon is inflated to maintain its placement. The procedure continues with the externalization of the catheter through a stab incision in the abdomen, where it is anchored to the abdominal wall. The construction of the gastric tube involves creating a stomach flap that is everted and sutured to the abdominal wall, ensuring that there is no undue tension on the stomach. This careful manipulation is vital for the successful placement of the gastrostomy tube, which is ultimately inserted into the abdomen to provide a means of nutritional support. The entire process requires precision and attention to detail to ensure proper healing and function of the gastrostomy site.
© Copyright 2025 Coding Ahead. All rights reserved.
The open gastrostomy with construction of a gastric tube, as described by CPT® Code 43832, is indicated for patients who require long-term nutritional support through a direct feeding method into the stomach. This procedure is typically performed in cases where oral intake is not feasible due to various medical conditions. The following are specific indications for this procedure:
The procedure for an open gastrostomy with construction of a gastric tube involves several detailed steps to ensure proper placement and function of the gastric tube. The following outlines the procedural steps:
After the completion of the open gastrostomy with construction of a gastric tube, patients typically require monitoring for any complications such as infection or leakage at the stoma site. Post-procedure care includes ensuring the proper placement and function of the gastrostomy tube, as well as educating the patient or caregivers on how to care for the tube and manage feeding. Patients may also need follow-up appointments to assess the healing of the incision and the overall condition of the gastrostomy site. It is essential to monitor the patient's nutritional intake and adjust feeding protocols as necessary to ensure adequate nutrition and hydration.
| Short Descr | GSTRST OPEN W/CONSTJ TUBE | Medium Descr | GASTROSTOMY OPEN W/CONSTJ GASTRIC TUBE | Long Descr | Gastrostomy, open; with construction of gastric tube (eg, Janeway procedure) | 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) | P5E - Ambulatory procedures - other | MUE | 1 | CCS Clinical Classification | 71 - Gastrostomy, temporary and permanent |
| 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | 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. | 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). | A1 | Dressing for one wound | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | 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 and Medium Descriptions changed. |
| Pre-1990 | Added | Code added. |
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