General Surgery Coding Alert

Question: How would you code a hemigastrectomy?

Vermont Subscriber

Answer: Selecting the right code depends on the portion of stomach that was removed and how the reconstruction of the stomach and small bowel was performed, says Susan Callaway, CPC, CCS-P, an independent coding and reimbursement specialist and educator in North Augusta, S.C.

CPT 2001 lists three main gastrectomy codes:

43620 (gastrectomy, total; with esophagoenterostomy);

43631 (gastrectomy, partial, distal; with gastroduodenostomy); and,

43638 (gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy).

A hemigastrectomy implies that half the stomach was removed, therefore 43620 would not be correct. Depending on which portion of the stomach was removed, 43631 or 43638 should be used, Callaway says.

The other gastrectomy codes listed in the CPT manual (43632, gastrectomy, partial, distal, with
gastrojejunostomy; 43633, gastrectomy, partial, distal, with Roux-en-Y reconstruction; 43634, gastrectomy, partial, distal, with formation of intestinal pouch; and 43639, gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy; with pyloroplasty or pyloromyotomy) are variations of 43631 and 43638, Callaway notes. Choosing the correct code depends on how the intestine and the stomach were reconstructed following the gastrectomy.