2025 CPT code 43640
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Vagotomy, including pyloroplasty, with or without gastrostomy; truncal or selective.
Modifiers may be applicable based on the circumstances of the procedure (e.g., 22 for increased procedural services, 59 for distinct procedural service, and modifiers indicating the use of an assistant surgeon). Consult the most up-to-date CPT guidelines and local payer policies for appropriate modifier usage.
Medical necessity is established by documented failure of conservative medical management (e.g., medications to reduce acid production) for chronic or recurrent peptic ulcers, or by the presence of gastric outlet obstruction.
The surgeon performs the entire procedure, including the incision, vagus nerve resection, pyloroplasty, and closure of incisions.This requires advanced surgical skills and knowledge of anatomy.
In simple words: This surgery involves cutting parts of the vagus nerve (which controls stomach acid) and widening the opening between the stomach and small intestine. This is done to improve digestion and reduce stomach acid.The surgeon makes a cut in the abdomen, accesses and cuts the vagus nerve, and widens the stomach outlet.
This procedure involves transecting both trunks of the vagus nerve and performing a pyloroplasty to increase the caliber of the pyloric opening by stretching.A midline or left paramedian incision is made. The peritoneum over the abdominal part of the esophagus is carefully incised transversely to avoid damaging the inferior phrenic vessels. The lower 3 inches of the esophagus are mobilized and retracted downwards. The anterior and posterior trunks of the vagus nerve are identified and 5-7 cm segments of both trunks are resected. The remaining ends are ligated with fine silk sutures. A ligature is placed to prevent bleeding from the ascending esophageal vessels. The incision is closed with non-absorbable sutures. A pyloroplasty is then performed by making an incision through all layers of the pyloric canal midway between the greater and lesser curvatures, extending 3.5 cm proximal to the pylorus and 2.5 cm distally on the anterior duodenal wall. The duodenal and stomach contents are aspirated, and the inner wall is inspected for defects or stenosis. If present, these are excised. The incision edges are pulled apart to widen the pyloric canal, and the defect is closed with sutures.A gastrostomy may also be performed.
Example 1: A patient with chronic duodenal ulcers unresponsive to medical management undergoes a truncal vagotomy with pyloroplasty. , A patient with a history of recurrent peptic ulcers and gastric outlet obstruction undergoes a selective vagotomy combined with pyloroplasty and gastrostomy., A patient presents with severe peptic ulcer disease and undergoes a highly selective vagotomy.
Preoperative diagnosis clearly indicating the need for the procedure, operative report detailing the type of vagotomy performed (truncal or selective), pyloroplasty technique, and any additional procedures (e.g., gastrostomy).Pathology reports (if applicable),Postoperative progress notes documenting recovery and any complications.
** The choice between truncal and selective vagotomy depends on the patient's clinical presentation and the surgeon's preference.Accurate documentation is critical for appropriate reimbursement.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:General Surgery
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center