Summary & Overview
CPT 43651: Laparoscopic Truncal Vagotomy for Duodenal Ulcer
CPT code 43651 identifies a laparoscopic truncal vagotomy in which both main trunks of the vagus nerve are transected to treat a duodenal ulcer. The code denotes a minimally invasive surgical approach to acid-reduction therapy historically used for peptic ulcer disease management. Nationally, this code matters because it captures definitive surgical acid-reduction therapy that may be billed in inpatient and outpatient surgical settings and affects surgical service-line billing and quality reporting.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical intent behind the code, typical sites of service, and the service type. The publication provides billing benchmarks, common modifiers and coding considerations, and notes on clinical context relevant to payer coverage and claims adjudication. It also outlines the relationships between this code and related surgical interventions for peptic ulcer disease.
Data not available in the input for specific negotiated rates, associated taxonomies, and ICD-10 diagnosis mappings.
Billing Code Overview
CPT code 43651 describes a surgical procedure using a laparoscopic technique in which the provider transects both main trunks of the vagus nerve to treat a duodenal ulcer. This procedure is a form of truncal vagotomy performed minimally invasively.
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Service type: Surgical procedure — laparoscopic truncal vagotomy
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Typical site of service: Hospital operating room or ambulatory surgical center
Clinical & Coding Specifications
Clinical Context
A 54-year-old patient with a long-standing history of complicated peptic ulcer disease presents with recurrent duodenal ulceration despite medical therapy, including proton pump inhibitors and H. pylori eradication. Prior endoscopic evaluation documents a chronic, nonhealing duodenal ulcer with evidence of bleeding risk or refractory pain. After multidisciplinary review, the surgical team schedules a laparoscopic truncal vagotomy to transect both main trunks of the vagus nerve to reduce acid secretion and promote ulcer healing.
Preoperative workflow includes anesthesia evaluation, informed consent documenting risks and benefits of laparoscopic vagotomy versus more extensive ulcer surgery, preoperative imaging or endoscopy as indicated, and optimization of comorbid conditions. Intraoperative steps include laparoscopic access, identification of the anterior and posterior vagal trunks along the distal esophagus, transection of both main trunks, inspection for hemostasis, and optional accompanying procedures as clinically indicated. Postoperative care involves recovery from anesthesia, pain control, monitoring for complications (bleeding, infection, gastric emptying disorders), dietary advancement, and outpatient follow-up with gastroenterology and surgery to monitor ulcer healing and acid-related symptoms.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified modifier | Rarely used; not typically reported—use per payer rules when no specific modifier applies. |