Summary & Overview
CPT 43635: Gastric Resection with Vagotomy
CPT code 43635 denotes a surgical procedure that transects the vagus nerve and removes the distal portion of the stomach. This operation is performed for specific clinical indications that require both vagal denervation and partial gastrectomy. Nationally, procedures like this are significant due to their implications for complex surgical care, perioperative resource use, and surgical coding accuracy.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and the payer landscape relevant to billing and claims adjudication. The publication summarizes benchmark considerations, common modifiers associated with surgical services, and policy or coverage factors that commonly affect reimbursement and prior authorization for complex gastric surgery.
This summary equips payers, coding professionals, and surgical administrators with a clear understanding of what CPT code 43635 represents, why accurate coding matters for claims processing, and what types of documentation and clinical context are typically relevant. Data not available in the input are noted where applicable.
Billing Code Overview
CPT code 43635 describes a surgical procedure in which the provider transects the vagus nerve and removes the distal part of the stomach. This operation is a form of gastric resection combined with vagotomy.
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Service type: Surgical gastric resection with vagotomy
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Typical site of service: Inpatient hospital operating room or specialized surgical center
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with long-standing, medically refractory peptic ulcer disease and gastric outlet obstruction presents for definitive surgical management. The surgeon performs truncal vagotomy with antrectomy: the provider transects the vagus nerve and removes the distal portion of the stomach to reduce acid secretion and relieve obstruction. The typical workflow includes preoperative evaluation (history, physical, labs, endoscopy, imaging), informed consent discussing risks (bleeding, infection, leak, dumping syndrome), general anesthesia, operative time in an operating room with an open or laparoscopic approach as appropriate, intraoperative confirmation of adequate vagal transection and resection margins, gastrointestinal reconstruction (usually gastroduodenostomy or gastrojejunostomy), and postoperative monitoring in a PACU with transition to inpatient surgical floor care for pain control, nutrition advancement, and discharge planning. Typical site of service is an acute care inpatient hospital or ambulatory surgical center when clinically appropriate for minimally invasive approaches.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Not an actual standard CMS modifier (placeholder) | Data not available in the input. |
11 |