Summary & Overview

CPT 43652: Laparoscopic Selective or Highly Selective Vagotomy

CPT code 43652 designates a laparoscopic selective or highly selective vagotomy: a targeted surgical denervation of gastric vagal fibers (division of the anterior and posterior gastric nerves of Latarjet or denervation limited to the stomach fundus and body). This code is relevant nationally for facilities and surgeons who manage refractory peptic ulcer disease or other acid‑secretion disorders where vagotomy remains part of the operative armamentarium.

Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find clinical and billing context around the procedure, typical sites of service, and payer coverage considerations. The publication summarizes benchmarks and policy topics relevant to payers and providers, including utilization patterns, coding guidance, and common modifier usage where available. It also outlines clinical indications and procedural scope to aid accurate claim submission and coding consistency.

The report emphasizes concise operational detail: what the code represents, where the procedure is typically performed, and which payers are commonly involved. Data not available in the input is noted explicitly where relevant elsewhere in the full publication. This executive summary orients payers, surgical teams, and coding professionals to the essentials of CPT code 43652 for national-level application.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare43652CPTlaparoscopic surgeryvagotomygeneral surgerygastrointestinal surgeryoperative codingprocedure coding

Billing Code Overview

CPT code 43652 describes a laparoscopic selective or highly selective vagotomy, a surgical procedure that divides specific gastric vagal fibers (anterior and posterior gastric nerves of Latarjet for selective vagotomy, or denervation limited to the fundus and body for highly selective vagotomy). The procedure is performed using minimally invasive (laparoscopic) surgical technique.

Service type: Laparoscopic surgical denervation of the stomach (selective or highly selective vagotomy)
Typical site of service: Operating room in an acute care hospital or ambulatory surgical center where laparoscopic abdominal surgery is performed.

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient with chronic, refractory peptic ulcer disease and complications from acid hypersecretion is evaluated for surgical management after failing maximal medical therapy including proton pump inhibitors and H. pylori eradication when applicable. Workup includes upper endoscopy, gastric emptying assessment if indicated, and preoperative surgical clearance. The patient is scheduled for a laparoscopic selective or highly selective vagotomy (43652) performed by a general surgeon with advanced foregut expertise. Intraoperative workflow involves induction of general anesthesia, laparoscopic access with trocars, identification of the vagal trunks and gastric branches, selective division of the anterior and posterior gastric nerves of Latarjet only or denervation limited to fundus and body (parietal cell–containing areas) depending on surgical intent, hemostasis confirmation, and closure of port sites. Typical perioperative documentation includes operative report detailing technique (selective vs highly selective), targeted nerve branches, findings, estimated blood loss, complications, and disposition. Postoperative care includes pain control, diet advancement, monitoring for gastric emptying disturbance or reflux, and outpatient follow-up for symptom resolution and potential need for acid suppression therapy adjustments.

Coding Specifications

Modifier	Description	When to Use
`00`	Service not terminated as planned (platform-specific)

Taxonomy Code	Specialty	Notes
207K00000X	General Surgery	Most common specialty performing laparoscopic selective/highly selective vagotomy.
2080P0005X	Pediatric Surgery	Performs similar procedures in pediatric patients when indicated.
207L00000X	Thoracic Surgery	May be involved for complex foregut or mediastinal involvement.
207H00000X	Surgical Oncology	Involved when ulcer disease is associated with malignant processes requiring multidisciplinary care.
364S00000X	Gastroenterology (Interventional)	Rarely performs surgical vagotomy but involved in preoperative and postoperative endoscopic assessment.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`43235`	Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)	Preoperative diagnostic endoscopy to evaluate peptic ulcer disease and anatomy prior to `43652`.
`43280`	Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus, by balloon or bougie	Performed pre- or postoperatively for symptomatic strictures or dysphagia associated with peptic disease.
`43770`	Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (for obesity)	Not directly related but contextually shares laparoscopic foregut operative workflows and instrumentation; listed for operative sequencing awareness.
`43846`	Revision, gastric restrictive procedure (e.g., repair of gastrojejunostomy)	May be performed if prior gastric surgery complicates access for `43652`; relevant when prior operations exist.
`49999`	Unlisted procedure, abdomen, peritoneum, omentum	Used rarely for atypical or adjunct laparoscopic maneuvers not described by standard codes during the same operative session.

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