Summary & Overview
CPT 43622: Total Gastrectomy with Esophagoduodenal Pouch Reconstruction
CPT code 43622 represents a total gastrectomy with construction of an esophagoduodenal pouch to preserve an uninterrupted alimentary tract, most commonly performed for gastric malignancy. As a high-acuity oncologic abdominal procedure, it has significant clinical, perioperative and reimbursement implications across hospital systems and payers nationally. Key payers commonly included in evaluations of this code are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare and Medicare.
This publication provides a concise national overview of CPT code 43622, covering clinical context, typical site-of-service considerations, and the reimbursement and billing elements that influence hospital and surgeon workflows. Readers will find benchmarking information where available, common billing modifiers and claims considerations, and a summary of policy updates and coverage patterns that affect authorization, bundling, and post-acute care planning. The analysis is intended for hospital administrators, surgical departments, revenue cycle teams, and policy analysts seeking a practical reference on coding, coverage, and operational impacts for major upper gastrointestinal oncologic resections.
Billing Code Overview
CPT code 43622 describes a surgical procedure in which the entire stomach is removed (total gastrectomy) and a continuity-preserving pouch is created between the esophagus and duodenum to maintain an uninterrupted digestive tract. The procedure is typically performed for patients with gastric cancer requiring resection of the stomach.
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Service type: Major open or complex abdominal oncologic surgery involving resection and reconstruction of the upper gastrointestinal tract
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Typical site of service: Inpatient hospital, operating room, with postoperative inpatient recovery
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with biopsy-proven distal gastric adenocarcinoma presents with symptomatic gastric outlet obstruction and weight loss. After staging imaging shows localized disease without distant metastasis and a multidisciplinary tumor board recommends definitive surgical resection, the surgical team schedules a total gastrectomy with Roux-en-Y esophagojejunostomy reconstruction. The patient undergoes general anesthesia, perioperative antibiotics, and VTE prophylaxis. The operative workflow includes laparotomy (or laparoscopic-assisted approach), mobilization of the stomach, lymphadenectomy as indicated for oncologic margins, division of vascular supply, resection of the entire stomach, creation of a jejunal Roux limb, and construction of an esophagojejunostomy pouch to re-establish an uninterrupted alimentary tract. Postoperative care includes ICU or step-down monitoring for hemodynamic stability, early enteral nutrition via jejunostomy or nasoenteric tube if placed, pain control, and surveillance for complications such as anastomotic leak, bleeding, or pneumonia. Typical site of service is an inpatient acute care hospital; this is a major operative procedure performed by general surgeons specializing in surgical oncology or foregut surgery. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Procedure code change | Rarely used; applies when a code change is reported by a facility for internal purposes per payer rules |