General Surgery Coding Alert

Question: What is hemigastrectomy, and how should I code for it? Arizona Subscriber Answer: Hemigastrectomy means partial ("hemi") removal of the stomach ("gastrectomy"). CPT includes three primary gastrectomy codes:
43620 - Gastrectomy, total; with esophagoenterostomy
43631 - Gastrectomy, partial, distal; with gastroduodenostomy
43638 - Gastrectomy, partial, proximal, thoracic or abdominal approach including esophagogastrostomy, with vagotomy. Because 43620 describes a total removal, you would not bill this code for a hemigastrectomy. Therefore, depending on which portion of the stomach the surgeon removed, you would report either 43631 or 43638. The remaining gastrectomy codes (43632, Gastrectomy, partial, distal; with gastro-jejunostomy; 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 esopha-gogastrostomy, with vagotomy; with pyloroplasty or pyloromyotomy) are variations of 43631 and 43638. You must choose the correct code depending on how the surgeon reconstructed the intestine and the stomach following gastrectomy. If documentation does not specify the method employed, be sure to consult with the surgeon for clarification before selecting a code. - Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb.