Summary & Overview
CPT 43870: Gastrostomy Closure, Surgical
CPT code 43870 denotes the surgical closure of a gastrostomy, a procedure performed to close an existing opening in the stomach that was placed for enteral feeding or gastric decompression. This code is relevant nationally as gastrostomy placement and subsequent closure occur across inpatient and outpatient surgical settings, affecting surgical, hospital, and post-acute payment streams. The code signals a definitive surgical intervention to restore gastric continuity and minimize ongoing device- or tract-related complications.
Key payers considered in this context include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clinical and billing-focused overview that situates CPT code 43870 within surgical service lines and typical sites of care. The publication outlines common clinical scenarios prompting gastrostomy closure, operational considerations for coding and site-of-service classification, and benchmark-oriented content such as utilization patterns and payer coverage notes where available. It also highlights policy-relevant topics affecting surgical billing, including documentation expectations and setting determinations. Data not available in the input will be explicitly identified in specific sections.
Billing Code Overview
CPT code 43870 describes the surgical closure of a gastrostomy created for patients who require direct gastric feeding or decompression of the upper gastrointestinal tract. The procedure involves removing or closing the gastrostomy tract and restoring gastric integrity.
Service type: Surgical — Gastrointestinal procedure
Typical site of service: Hospital operating room or ambulatory surgical center, depending on clinical complexity and patient condition.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a healed but no longer necessary percutaneous endoscopic gastrostomy (PEG) tube presents for planned removal and formal closure of the gastrostomy tract. The patient was originally receiving enteral nutrition via the gastrostomy for dysphagia following a cerebrovascular accident. Preoperative evaluation includes history and physical, review of anticoagulation, and imaging or contrast study if there is concern for persistent fistula or intraperitoneal communication. The procedure typically occurs in an operating room or ambulatory surgical center under monitored anesthesia care or general anesthesia. The surgeon excises the external skin scar and mature tract, closes the abdominal wall in layers, and ensures secure fascial and skin closure. Postoperative workflow includes recovery room monitoring for return of bowel function, pain control, wound care instructions, and follow-up to assess for wound infection or persistent fistula. Typical payors involved in authorization and claims adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No collective definition in CMS standard modifier list (use per payer policy) | Data not available in the input; follow payer-specific guidance |
11 |