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CPT 43610: Surgical Exploration of Stomach with Lesion Excision
CPT code 43610 designates open surgical exploration of the stomach for an ulcer or tumor with excision of the lesion when identified. This procedure is clinically important because untreated gastric ulcers or tumors can cause significant morbidity from bleeding or gastric outlet obstruction; timely surgical management can be definitive for selected lesions. Nationally, this code maps to surgical services performed in hospital operating rooms, both inpatient and outpatient, and is relevant for general surgery and surgical oncology case mix and utilization.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a focused account of what the code represents, typical sites of service, and the clinical context that drives billing for this procedure. The publication provides benchmarks where available, notes common billing modifiers and administrative considerations, and summarizes clinical indications tied to use of the code. It is intended to help coders, billers, and policy analysts understand the procedural definition and operational settings associated with CPT code 43610 and to identify the types of documentation and clinical scenarios that commonly generate claims for this service.
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Billing Code Overview
CPT code 43610 describes an operative procedure in which the surgeon explores the stomach to identify an ulcer or tumor and excises the lesion if found. The service addresses lesions that, if untreated, may lead to bleeding or gastric outlet obstruction.
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Service type: Open surgical exploration of the stomach with excision of lesion
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Typical site of service: Hospital operating room (inpatient or outpatient surgical setting)
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