Summary & Overview
CPT 43860: Revision/Reconstruction of Gastrojejunostomy, Possible Partial Gastrectomy
Headline: CPT code 43860 covers surgical revision or reconstruction of a prior gastrojejunostomy, often with partial gastrectomy
Lead: CPT code 43860 identifies procedures to revise or reconstruct a previously created anastomosis between the stomach and jejunum, typically performed to relieve obstruction, pain, or symptoms from scarring, adhesions, or disease progression. This code captures complex revisional gastrointestinal surgery with implications for surgical quality, utilization, and inpatient resource use.
Why it matters: Nationally, procedures represented by CPT code 43860 are important for managing complications or progression after prior gastric surgery. These interventions can be resource intensive, affect length of stay, and carry clinical risk, making accurate coding essential for care coordination and payment integrity.
Key payers: Analysis commonly covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides clinical context for CPT code 43860, outlines typical service settings, and summarizes common payer coverage patterns and billing considerations. It highlights benchmark metrics and policy updates where available, and situates the code within surgical service lines for hospitals and ambulatory surgery centers. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 43860 describes revision or reconstruction of a previously created gastrojejunostomy (an anastomosis between the stomach and jejunum). The procedure may include a partial gastrectomy when indicated and is performed to relieve obstruction, pain, or other symptoms caused by scarring, adhesions, or progression of the underlying disease related to the original surgery.
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Service type: Surgical revision/reconstruction of prior gastrojejunostomy, potentially including partial gastrectomy
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Typical site of service: Inpatient or outpatient surgical setting (operating room), commonly within hospital surgical services or ambulatory surgery centers depending on clinical status and complexity.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a prior gastrojejunostomy for peptic ulcer disease presents with progressive postprandial vomiting, abdominal pain, and weight loss. Imaging and endoscopy demonstrate stenosis and scarring at the gastrojejunal anastomosis with upstream gastric dilation. The surgical team schedules a revision of the gastrojejunostomy (CPT code 43860) to relieve obstruction; intraoperatively the surgeon encounters dense adhesions and performs adhesiolysis and partial gastrectomy to resect the stenotic segment and recreate a patent anastomosis. The clinical workflow includes preoperative evaluation (history, labs, imaging, anesthesia assessment), informed consent discussing risks of reoperation and potential need for gastrectomy, operative documentation of the revision/reconstruction and any additional procedures (e.g., partial gastrectomy, lysis of adhesions), anesthesia monitoring and post-anesthesia care, inpatient postoperative monitoring for leak, infection, or obstruction, and discharge planning with follow-up for nutritional counseling and wound care. Payors involved may include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for coverage adjudication and medical necessity review.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when operative complexity and work substantially exceed typical requirements (document specifics). |