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Official Description

Gastrectomy, partial, distal; with formation of intestinal pouch

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The procedure described by CPT® Code 43634 refers to a partial gastrectomy, specifically a distal gastrectomy, which involves the surgical removal of a portion of the stomach. This operation is performed through an upper midline abdominal incision that allows the surgeon to access the stomach and explore the abdominal cavity. During the procedure, the stomach is carefully mobilized, and clamps are applied to delineate the area of resection. The stomach is transected just distal to the clamp, and the duodenum is transected proximal to the clamp, resulting in the removal of the distal aspect of the stomach. Unlike the procedure described in CPT® Code 43633, which includes a Roux-en-Y reconstruction, the focus of CPT® Code 43634 is on the creation of an intestinal pouch. This involves mobilizing a long segment of the small intestine, which is then folded back on itself to form a reservoir or pouch. The pouch is subsequently anastomosed to the remaining stomach and the small bowel, facilitating the continuity of the digestive tract. This procedure is typically indicated for various gastrointestinal conditions that necessitate the removal of part of the stomach while preserving digestive function through the creation of the pouch.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The procedure described by CPT® Code 43634 is indicated for various gastrointestinal conditions that may require surgical intervention. These indications may include:

  • Malignancy - The presence of cancerous tumors in the distal stomach that necessitate partial removal to prevent further spread.
  • Peptic Ulcer Disease - Severe cases of peptic ulcers that do not respond to medical management and require surgical intervention to alleviate symptoms and prevent complications.
  • Gastric Outlet Obstruction - Conditions that lead to blockage at the outlet of the stomach, causing significant digestive issues and necessitating surgical correction.
  • Benign Tumors - Non-cancerous growths in the stomach that may cause symptoms or complications, warranting surgical removal.

2. Procedure

The procedure for CPT® Code 43634 involves several critical steps to ensure successful completion of the distal gastrectomy with intestinal pouch formation. The steps are as follows:

  • Step 1: Incision and Access - An upper midline abdominal incision is made to provide access to the stomach. This incision allows the surgeon to explore the abdominal cavity and assess the surrounding structures.
  • Step 2: Mobilization of the Stomach - The stomach is carefully mobilized to facilitate the surgical procedure. This involves freeing the stomach from its attachments to surrounding tissues, allowing for better visualization and access.
  • Step 3: Clamping and Transection - Clamps are placed across the stomach just above the planned transection site and just below the gastroduodenal junction. The stomach is then transected just distal to the clamp, and the duodenum is transected proximal to the clamp, resulting in the removal of the distal aspect of the stomach.
  • Step 4: Creation of the Intestinal Pouch - A long segment of the small bowel (jejunum) is mobilized and folded back on itself in an S or J configuration. This segment is then incised and sutured to create a reservoir or pouch.
  • Step 5: Anastomosis - The newly created intestinal pouch is anastomosed to the remaining portion of the stomach, and the proximal end of the jejunum is anastomosed to the side of the pouch, ensuring continuity of the digestive tract.

3. Post-Procedure

After the completion of the procedure, patients typically require monitoring in a postoperative setting to assess recovery. Post-procedure care may include pain management, monitoring for any signs of complications such as infection or leakage from the anastomosis, and gradual reintroduction of oral intake as tolerated. Patients may also need dietary modifications to accommodate the changes in their digestive system following the creation of the intestinal pouch. Follow-up appointments are essential to evaluate the patient's recovery and to ensure proper healing and function of the gastrointestinal tract.

Short Descr REMOVAL OF STOMACH PARTIAL
Medium Descr GSTRCT PRTL DSTL W/FRMJ INTSTINAL POUCH
Long Descr Gastrectomy, partial, distal; with formation of intestinal pouch
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.

43635 Addon Code MPFS Status: Active Code APC C CPT Assistant Article Illustration for Code Vagotomy when performed with partial distal gastrectomy (List separately in addition to code[s] for primary procedure)
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).
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
82 Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code 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
Date
Action
Notes
2011-01-01 Changed Short description changed.
1994-01-01 Added First appearance in code book in 1994.
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