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BETA v.3.0

2025 CPT code 43622

Total gastrectomy with formation of an intestinal pouch.

Modifiers may be applicable. Modifier 22 (Increased Procedural Services) is used for unusually complex cases. Modifier 51 (Multiple Procedures) is used when other procedures are performed during the same session. Modifiers 52 through 58, 76 through 79, and 80 through 82 might be relevant depending on specific circumstances such as reduced services, staged procedures, or involvement of assistant surgeons. Modifier 99 indicates multiple modifiers are present. Modifiers related to physician location (AQ, AR, AS), specific circumstances (CR, ET, GA, GC, GJ, GR), and billing arrangements (KX, Q5, Q6, QJ) might also be used if applicable.

Medical necessity must be clearly documented. This usually involves demonstrating that less invasive treatments are not suitable and that the total gastrectomy with pouch formation is necessary to address a life-threatening or significantly debilitating condition (e.g., cancer, severe gastric dysfunction). The documentation should link the procedure to the patient's specific condition and expected benefits.

The surgeon is responsible for the complete removal of the stomach and surrounding tissues, including lymph nodes. They must also meticulously construct the intestinal pouch and ensure its proper connection to the remaining digestive tract. This requires advanced surgical skills and knowledge of anatomy and physiology.

In simple words: The surgeon removes the entire stomach and creates a small pouch from the intestine. This pouch acts like a new, smaller stomach and is connected to the esophagus (the food pipe) and the intestines so the patient can still digest food.

This procedure involves the complete removal of the stomach and the creation of a pouch from a section of the small intestine (often the jejunum). This pouch is then connected to the esophagus and the duodenum (or another part of the small intestine) to restore the digestive tract's continuity. This complex procedure is typically performed to treat stomach cancer or other severe gastric conditions. It involves the careful dissection and removal of the stomach, surrounding lymph nodes, and portions of the omentum. The creation of the intestinal pouch requires meticulous surgical technique to ensure proper function and minimize complications.

Example 1: A patient with advanced stomach cancer undergoes a total gastrectomy with intestinal pouch formation (43622) to remove the cancerous tissue and restore digestive function., A patient with a non-cancerous but severely dysfunctional stomach (e.g., gastroparesis refractory to other treatments) has a total gastrectomy and intestinal pouch reconstruction (43622)., Following a traumatic injury to the stomach resulting in irreparable damage, a patient undergoes 43622 (total gastrectomy with intestinal pouch creation) to remove the damaged organ and enable digestive continuity.

Documentation should include operative reports detailing the extent of the gastrectomy, the type of intestinal pouch created, and any complications encountered. Pathology reports confirming the diagnosis (e.g., cancer) are crucial. Post-operative notes should track the patient's recovery, nutritional status, and any complications.

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