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The procedure described by CPT® Code 43622 refers to a total gastrectomy with the formation of an intestinal pouch. This surgical intervention involves the complete removal of the stomach, which is accessed through an upper midline abdominal incision. The procedure begins with an exploration of the abdominal cavity to assess the surrounding structures. The stomach is then mobilized, and clamps are strategically placed above the gastroesophageal junction and below the gastroduodenal junction to facilitate the transection of the esophagus and duodenum. Following the removal of the stomach, the surgical focus shifts to the creation of an intestinal pouch. This involves mobilizing a long segment of the small intestine, which is then folded back on itself in a specific configuration, either S or J-shaped. This segment is incised and sutured to form a reservoir or pouch. The final step of the procedure includes anastomosing the newly created pouch to the esophagus and the remaining segment of the small bowel, ensuring continuity of the gastrointestinal tract. This complex surgical procedure is typically indicated for various conditions affecting the stomach, necessitating its complete removal and reconstruction of the digestive pathway.
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The total gastrectomy with formation of an intestinal pouch, as described by CPT® Code 43622, is indicated for several specific medical conditions. These may include:
The procedure for CPT® Code 43622 involves several critical steps that ensure the successful removal of the stomach and the creation of an intestinal pouch. The first step is the creation of an upper midline abdominal incision, which allows access to the abdominal cavity. Once the incision is made, the surgeon explores the abdominal cavity to assess the condition of the stomach and surrounding organs. Following this exploration, the stomach is mobilized, and clamps are placed strategically above the gastroesophageal junction and below the gastroduodenal junction. This positioning is crucial as it facilitates the transection of the esophagus just distal to the clamp and the duodenum proximal to the clamp. After the stomach is completely transected and removed, the focus shifts to the formation of the intestinal pouch. A long segment of the small bowel is mobilized, which is then folded back on itself in either an S or J configuration. This segment is incised and sutured to create a reservoir or pouch. Finally, the newly formed pouch is anastomosed to the esophagus and the remaining segment of the small bowel, ensuring that the digestive tract remains continuous and functional.
Post-procedure care following a total gastrectomy with intestinal pouch formation is critical for patient recovery. Patients are typically monitored closely in a postoperative setting for any complications such as infection, bleeding, or anastomotic leaks. Nutritional support is essential, as patients will need to adapt to a new dietary regimen due to the absence of the stomach. Initially, a liquid diet may be recommended, gradually transitioning to soft foods as tolerated. Follow-up appointments are necessary to assess the healing process and to provide guidance on dietary modifications and lifestyle changes. Patients may also require education on potential long-term effects, such as changes in digestion and absorption, and the importance of vitamin and mineral supplementation to prevent deficiencies.
| Short Descr | REMOVAL OF STOMACH | Medium Descr | GSTRCT TOT W/FRMJ INTSTINAL POUCH ANY TYPE | Long Descr | Gastrectomy, total; with formation of intestinal pouch, any type | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 74 - Gastrectomy, partial and total |
This is a primary code that can be used with these additional add-on codes.
| 96547 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; first 60 minutes (List separately in addition to code for primary procedure) | 96548 | Add On Code MPFS Status: Active Code APC N Intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) procedure, including separate incision(s) and closure, when performed; each additional 30 minutes (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 62 | Two surgeons: when 2 surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding modifier 62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. each surgeon should report the co-surgery once using the same procedure code. if additional procedure(s) (including add-on procedure(s) are performed during the same surgical session, separate code(s) may also be reported with modifier 62 added. note: if a co-surgeon acts as an assistant in the performance of additional procedure(s), other than those reported with the modifier 62, during the same surgical session, those services may be reported using separate procedure code(s) with modifier 80 or modifier 82 added, as appropriate. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician |
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| 1994-01-01 | Added | First appearance in code book in 1994. |
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