Summary & Overview
CPT 43800: Repair of Pylorus by Stretching to Increase Pyloric Caliber
CPT code 43800 represents a surgical pyloric repair procedure that increases the caliber of the pyloric opening by stretching (pyloroplasty/stretching). This procedure is clinically relevant for treating pyloric obstruction or stenosis and influences surgical care pathways, hospital resource use, and national billing patterns. The code is used in operative reporting and billing for procedures performed in an operating room or ambulatory surgical setting.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the clinical context for CPT code 43800, the typical sites of service, and what to expect in terms of coding classification. The report also outlines where benchmarks and policy updates would apply and highlights areas for further review when payers publish coverage policies or payment edits.
This summary is intended for a national audience seeking a clear operational and coding-level understanding of CPT code 43800 and what its use implies for surgical service lines, billing staff, and revenue cycle stakeholders. Data not available in the input where details were not provided.
Billing Code Overview
CPT code 43800 describes a surgical procedure to repair the pylorus by stretching to increase the caliber of the pyloric opening. The service type is a pyloroplasty/stretching procedure intended to relieve pyloric stenosis or obstruction by mechanically widening the pyloric channel.
Typical site of service for CPT code 43800 is an operating room or surgical suite within a hospital or ambulatory surgery center, where intraoperative assessment and controlled surgical manipulation of the pylorus are performed.
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Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with longstanding peptic ulcer disease presents with progressive gastric outlet obstruction characterized by postprandial vomiting, early satiety, and weight loss. Diagnostic workup includes upper endoscopy demonstrating a narrowed pyloric channel with impaired gastric emptying and contrast imaging confirming delay. The surgical team schedules an operative pyloroplasty to increase the caliber of the pyloric opening by stretching under general anesthesia. Typical workflow: preoperative evaluation and consent; anesthesia induction; upper abdominal exposure (open or minimally invasive) and pyloric repair/stretching to widen the pyloric channel; intraoperative assessment of gastric emptying; closure and postoperative monitoring for return of bowel function. Typical site of service: inpatient hospital operating room or ambulatory surgery center depending on patient comorbidity and complexity. Usual providers: general surgeon or surgical subspecialist with expertise in foregut procedures. Perioperative care includes NPO status, IV fluids, antiemetic prophylaxis, pain control, and short-term nasogastric decompression as indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Standard reporting when no modifier applies |
22 |