Summary & Overview
CPT 43880: Closure of Gastrocolic Fistula, Surgical Repair
CPT code 43880 denotes the surgical closure of a gastrocolic fistula, a clinically significant procedure that addresses an abnormal tract between the stomach and colon. Gastrocolic fistulas commonly arise after prior gastroenteric or bariatric surgery or from untreated gastric ulcers; closure typically requires operative exploration and tailored repair techniques. Nationally, this code captures complex general or bariatric surgical care with implications for inpatient surgical utilization, post-operative resource use, and surgical quality measurement.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a focused overview of clinical context and service setting, benchmarks for utilization and typical care pathways where available, and a concise summary of relevant policy considerations that affect coding and hospital billing. The publication clarifies the procedure's scope, expected sites of service, and common clinical scenarios that lead to its use. Data not provided in the input, such as specific ICD-10 diagnosis pairings, payer-specific coverage rules, and associated taxonomies, are noted as not available in the input. This summary serves clinicians, coding professionals, and policy analysts seeking a national-level understanding of CPT code 43880 and its role in surgical management of gastrocolic fistulas.
Billing Code Overview
CPT code 43880 describes a surgical procedure to close a gastrocolic fistula, using variable techniques selected by the surgeon based on intraoperative findings. The service involves identifying and repairing an abnormal connection between the stomach and the colon, often encountered after prior gastroenteric or bariatric surgery or as a complication of untreated gastric ulcers.
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Service type: Surgical repair of a gastrocolic fistula
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Typical site of service: Inpatient or outpatient surgical setting, most commonly performed in an operating room under general anesthesia
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old with a history of prior gastric surgery who presents with chronic feculent vomiting, weight loss, and recurrent aspiration. Imaging and endoscopy confirm a gastrocolic fistula between the stomach and transverse colon. The patient is optimized preoperatively for nutrition and infection risk, receives broad-spectrum antibiotics, and undergoes operative repair under general anesthesia. The surgical team explores the abdomen, identifies the fistulous tract, mobilizes stomach and colonic tissues, excises the fistula, closes defects (primary repair, patch, or resection with anastomosis as indicated), and places drains as needed. Postoperative care includes ICU or step-down monitoring for sepsis risk, bowel rest with enteral or parenteral nutrition, pain control, and follow-up imaging or contrast studies to confirm fistula closure. Typical sites of service are the inpatient operating room or, rarely, an ambulatory surgical center only for highly selected, low-risk cases.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (CMS default) | Use when no specific modifier is required and the procedure is reported as usual. |
11 | Physician/Practitioner Primary Service |