Summary & Overview
CPT 43865: Gastrointestinal Surgical Procedure
CPT code 43865 designates a specific gastrointestinal surgical procedure. Nationally, surgical procedure codes like this are important for clinical documentation, claims processing, and payer adjudication because they capture operative interventions that drive inpatient and outpatient surgical volumes and have implications for resource allocation and quality measurement. Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical role, typical sites of service, and the payer landscape; benchmark concepts such as utilization patterns and reimbursement considerations; and relevant policy and coding updates that affect billing and coverage. The summary equips billing professionals, clinical coders, and policy analysts with context about where this code fits in surgical service lines and what to expect in payer interactions. Data not available in the input.
Billing Code Overview
CPT code 43865 represents a surgical procedure in the realm of gastrointestinal surgery. Data not available in the input.
Service Type: Data not available in the input.
Typical Site of Service: Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old male with chronic gastroesophageal reflux disease who presents with progressive dysphagia, regurgitation, and recurrent aspiration. Esophagogastroduodenoscopy with laparoscopic fundoplication is planned due to a large paraesophageal hiatal hernia and refractory reflux. The procedure involves laparoscopic reduction of the herniated stomach, crural repair, and fundoplication (augmentation of the lower esophageal sphincter). The perioperative workflow includes preoperative history and physical, informed consent, general anesthesia, laparoscopic port placement, intraoperative endoscopic assessment as needed, hernia sac reduction, mobilization of the esophagus, posterior cruroplasty, creation of a 360-degree (Nissen) or partial (Toupet) fundoplication, hemostasis, and closure. Postoperative care includes PACU monitoring, pain control, early ambulation, diet advancement, and outpatient follow-up for wound check and symptom assessment. Typical site of service is an ambulatory surgery center or hospital operating room.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity substantially exceeds typical for the procedure (extensive adhesiolysis, difficult dissection). |
23 |