2025 CPT code 43641
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Parietal cell (highly selective) vagotomy with pyloroplasty, with or without gastrostomy.
Modifiers 51 (Multiple Procedures), 58 (Staged or Related Procedure), 62 (Two Surgeons), 78 (Unplanned Return to OR), and others may be applicable depending on the specific circumstances of the procedure.
Medical necessity is established based on the presence of documented peptic ulcer disease refractory to medical management, or in cases of severe gastroparesis significantly impacting quality of life and nutritional status.Documentation should demonstrate failure of conservative management and the need for surgical intervention.
The surgeon performs the incision, dissects the vagus nerve, ligates and divides the gastric branches, accesses the posterior trunk (if needed), incises the pyloric canal, widens the opening, and closes the defect.The procedure requires expertise in abdominal surgery and knowledge of the vagus nerve anatomy.
In simple words: The doctor performs surgery to reduce stomach acid by cutting specific nerves (vagotomy) and widens the opening between the stomach and small intestine (pyloroplasty) to improve digestion.This may also involve creating an opening in the stomach.
This procedure involves a highly selective vagotomy targeting the parietal cells in the stomach to reduce acid production, combined with pyloroplasty to widen the pyloric opening and improve gastric emptying.A gastrostomy (creation of a stomach opening) may or may not be performed as part of this procedure. The surgeon incises the abdominal skin, accesses the lesser sac, dissects the anterior vagus nerve, ligates and divides gastric branches. For posterior vagotomy, the peritoneum is incised, and blunt dissection is used to reach the posterior trunk.The pyloric canal is incised midway between the curvatures, contents aspirated, and the incision is widened to increase the pyloric diameter.The defect is then closed with sutures.The nerves of Latarjet, supplying the antrum and pylorus, are preserved.
Example 1: A patient with a history of recurrent peptic ulcers unresponsive to medical management undergoes a highly selective vagotomy with pyloroplasty to reduce acid secretion and improve gastric emptying., A patient with a duodenal ulcer requiring surgical intervention undergoes a highly selective vagotomy with pyloroplasty as part of the surgical repair., A patient with severe gastroparesis and impaired gastric emptying undergoes this procedure to improve the passage of food from the stomach.
Preoperative evaluation including patient history, physical examination, and relevant diagnostic testing (e.g., endoscopy, imaging studies). Operative report detailing the surgical technique, findings, and complications. Postoperative care plan, including pain management, dietary instructions, and follow-up appointments. Pathology report (if applicable).
** This procedure is considered a highly specialized surgical technique requiring advanced surgical skills and experience.The choice between this procedure and other surgical approaches (e.g., truncal vagotomy) depends on the specific clinical presentation and surgeon preference.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:General Surgery, Gastroenterology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center