Summary & Overview

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.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare43610CPTgastric surgerystomach explorationlesion excisionsurgical proceduregeneral surgerysurgical oncology

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.

Service type: Open surgical exploration of the stomach with excision of lesion
Typical site of service: Hospital operating room (inpatient or outpatient surgical setting)

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 58-year-old patient presents with progressive epigastric pain, early satiety, and intermittent melena. Upper endoscopy suggests a suspicious gastric lesion; the surgical team schedules an open exploratory gastrotomy with excision of the lesion for definitive diagnosis and treatment. The procedure is performed in an operating room at an ambulatory surgery center or hospital inpatient surgical suite under general anesthesia. The surgeon explores the stomach, identifies the ulcerated or tumorous lesion, and excises it with appropriate margins. Resected tissue is sent for pathological evaluation. Intraoperative considerations include control of bleeding, assessment for gastric outlet obstruction, possible frozen section consultation, and decision-making regarding further gastric resection if malignancy or extensive disease is identified. Postoperatively the patient is observed in recovery and discharged to inpatient care or home based on clinical status and the extent of surgery.

Coding Specifications

Modifier	Description	When to Use
`51`	Multiple procedures	When additional distinct surgical procedures are reported on the same day by the same provider in addition to the gastrotomy/excision.
`52`	Reduced services	When the excision is partially reduced or not completed as originally planned.
`53`	Discontinued procedure	If the operation is started but stopped due to extenuating circumstances prior to completion.
`59`	Distinct procedural service	To indicate a separate and distinct excision when multiple procedures occur in the same operative field and documentation supports separateness.
`62`	Two surgeons	When two surgeons work together as primary surgeons performing portions of the procedure.
`66`	Surgical team	When a surgical team (multiple surgeons with defined roles) performs the operation.
`22`	Increased procedural services	When work exceeds typical effort (e.g., extensive adhesiolysis, difficult exposure) and documentation supports unusual work.
`26`	Professional component	When only the surgeon’s professional component is billed separate from technical facility charges (rare for this code).
`78`	Return to OR for related procedure during global period	When the patient returns to the operating room for a related procedure during the global post-operative period.
`79`	Unrelated procedure or service during global period	When a subsequent unrelated surgery is performed during the global period.
`50`	Bilateral procedure	If bilateral gastric procedures are applicable (rare for a single gastric lesion) and documentation supports bilateral work.
`53`	Discontinued procedure	(Duplicate entry avoided; included above)

Taxonomy Code	Specialty	Notes
208000000X	General Surgery	Most common specialty performing exploratory gastrotomy with lesion excision.
208600000X	Surgical Oncology	Performs gastric resections when malignancy is suspected.
207Q00000X	Gastroenterology (Therapeutic)	May perform diagnostic endoscopic evaluation; not typically performing open excisions but involved in diagnostic workflow.
363L00000X	Anesthesiology	Provides anesthesia services for this operative procedure.
207L00000X	Diagnostic Radiology	May assist intraoperatively with imaging or preoperative localization.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`K25.9`	Gastric ulcer, unspecified as acute or chronic, without bleeding or perforation	Peptic ulcer disease that may require surgical exploration and excision if refractory or complicated.
`K27.9`	Peptic ulcer, site unspecified, unspecified as acute or chronic, without bleeding or perforation	Represents peptic ulcer disease when exact location is unclear; may prompt exploration.
`C16.9`	Malignant neoplasm of stomach, unspecified	Gastric cancer suspected preoperatively or discovered intraoperatively, necessitating excision and staging.
`K31.2`	Gastric polyp	Benign polypoid lesions that may be excised surgically if not amenable to endoscopic removal.
`R19.7`	Diarrhea, unspecified	Symptom that can be associated with gastric pathology prompting diagnostic surgery.
`K29.70`	Gastritis, unspecified, without bleeding	Inflammatory gastric conditions that can coexist with ulcers or masses and be evaluated during exploration.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy, flexible, transoral; with biopsy, single or multiple	Preoperative diagnostic endoscopy often performed to visualize and biopsy suspicious gastric lesions before operative excision.
`43239`	Upper gastrointestinal endoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery	Endoscopic therapeutic removal when lesion is amenable to endoscopic excision instead of open surgical excision.
`43611`	Gastrostomy; with wedge resection of stomach lesion (Note: adjunct code — verify current codebook)	Performed when lesion excision requires creation of a gastrostomy or wedge resection as part of definitive treatment.
`88305`	Surgical pathology, gross and microscopic examination	Pathologic evaluation of the excised gastric specimen for definitive diagnosis and margin assessment.
`76942`	Ultrasonic guidance for needle placement (e.g., intraoperative ultrasound)	Intraoperative imaging guidance when localization of lesion or avoiding vital structures is necessary.
`11042`	Debridement, subcutaneous tissues and muscle (if extensive soft tissue debridement required)	Used when significant soft-tissue work is performed in conjunction with the gastric procedure.