Summary & Overview
CPT 43840: Repair and Suture of Stomach Tear
CPT code 43840 denotes surgical suturing of a tear in the stomach wall, commonly performed for gastric perforations from peptic ulcer disease or traumatic injury. This operative repair is a critical emergency or urgent procedure to close full-thickness gastric defects and prevent peritonitis, sepsis, and other severe complications. Nationally, timely recognition and operative management of gastric perforation affect patient outcomes and hospital resource use.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, sites of service, and typical service lines associated with CPT code 43840. The publication also summarizes common billing considerations, typical modifiers used with operative codes, and benchmarking themes relevant to hospitals and surgical groups. Additionally, the content outlines where to look for policy updates and payer-specific coverage patterns that can affect prior authorization and claims adjudication.
This resource is intended for revenue cycle leaders, surgical administrators, and clinicians seeking a clear, national-level reference on the clinical meaning and billing context for CPT code 43840.
Billing Code Overview
CPT code 43840 describes the surgical repair and suturing of a tear in the stomach wall. This procedure addresses full-thickness defects that may result from a peptic ulcer that has eroded through the gastric wall or from an external traumatic injury.
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Service type: Surgical repair (open or laparoscopic) of gastric perforation/tear
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Typical site of service: Hospital operating room or surgicenter, commonly performed by general or trauma surgeons under operative care
Clinical & Coding Specifications
Clinical Context
A typical patient is a 56-year-old male who presents to the emergency department with acute-onset, severe epigastric pain, rebound tenderness, hypotension, and signs of peritonitis. Imaging (CT abdomen) shows free intraperitoneal air and contrast extravasation suggestive of a perforated gastric ulcer. The patient is taken urgently to the operating room for exploratory laparotomy. Intraoperatively the surgeon identifies a full-thickness gastric wall defect and performs primary repair with layered suturing, irrigation, and possible omental (Graham) patch as needed. The clinical workflow includes preoperative resuscitation and antibiotics, anesthesia evaluation, informed consent, operative documentation of the gastric tear and repair, intraoperative specimen handling if biopsy is taken, postoperative monitoring in the PACU or ICU depending on hemodynamic stability, and discharge planning with instructions for acid suppression and H. pylori testing when indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when the gastric repair requires substantially greater work than typical due to extensive contamination, adhesions, or complex reconstruction. |
23 | Unusual anesthesia |