Summary & Overview
CPT 43640: Vagotomy with Pyloric Repair (Pyloroplasty)
CPT code 43640 represents a combined vagotomy and pyloric repair (pyloroplasty) in which both trunks of the vagus nerve are transected and the pylorus is surgically altered to widen its opening. This procedure affects gastric emptying and is clinically relevant for conditions leading to gastric outlet obstruction or refractory peptic ulcer disease. Nationally, this code is important for hospital and surgical specialty billing, utilization monitoring, and policy guidance around surgical management of upper gastrointestinal motility and obstruction.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides an overview of coding context, typical sites of service, and payer coverage considerations where available. Readers will find concise benchmarks on service classification, clinical context for appropriate use, and an outline of common modifiers and billing considerations. The report does not provide patient-level recommendations but presents a national framing for reimbursement pathways, coding clarity, and areas where payer policy language often affects claim adjudication. Data not available in the input for specific payer policies, utilization rates, or associated ICD-10 diagnosis mappings.
Billing Code Overview
CPT code 43640 describes a surgical procedure in which the surgeon transects both trunks of the vagus nerve and performs a pyloric repair to increase the caliber of the pyloric opening by stretching. This service is a gastrointestinal surgical intervention focused on altering gastric emptying dynamics by vagotomy combined with pyloroplasty.
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Service type: Surgical procedure (abdominal/gastrointestinal surgery)
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Typical site of service: Hospital inpatient or outpatient surgical setting, including operating room or ambulatory surgery center
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with refractory peptic ulcer disease and chronic gastric outlet obstruction presents for surgical management. The patient has delayed gastric emptying with persistent vomiting, weight loss, and failure of medical therapy including proton pump inhibitors and endoscopic dilation. Preoperative evaluation includes labs, cross-sectional imaging or upper GI series, and anesthesia assessment. The surgeon performs a truncal vagotomy — transecting both vagal trunks — combined with a pyloroplasty to widen the pyloric channel and facilitate gastric emptying. The procedure is typically performed in an operating room under general endotracheal anesthesia. Intraoperative steps include exploration of the stomach and duodenum, identification and transection of the anterior and posterior vagus trunks, and repair/stretching of the pylorus (pyloroplasty). Postoperative workflow includes monitoring in PACU, pain control, nausea management, early ambulation, gradual advancement of diet from clear liquids to soft foods as tolerated, and discharge planning with wound care and follow-up to assess symptom relief and nutritional status.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased Procedural Services | Use when intraoperative work is substantially greater than usual for 43640 due to extensive adhesiolysis or complex anatomy. |