2025 CPT code 43999
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Surgery - Surgical Procedures on the Digestive System Surgery Feed
Unlisted procedure, stomach.
Modifiers may apply depending on the specific circumstances of the procedure.Consult the CPT manual for appropriate modifier usage.
Medical necessity must be clearly documented.This includes a clear indication of the patient's condition requiring the specific procedure, its severity, and why other existing codes are not applicable.The documentation must support the use of an unlisted code, and the medical necessity must be established and documented in the medical records.
The provider performs a laparoscopic or other surgical procedure on the stomach which is not listed in the CPT codebook.
In simple words: This code is used when a doctor does something new or unusual to the stomach that isn't already listed in the standard medical codes.The doctor will need to explain what they did and why to get paid for it.
Use code 43999 to report new or unusual procedures on the stomach that do not have an assigned code.This code is for procedures performed on the stomach that are not represented by any of the standard and active CPT codes.When using this unlisted procedure code, submit a cover letter explaining the reason for choosing it, include similar codes for comparison, and provide operative notes or relevant documentation to justify the claim amount.Payment is determined on a case-by-case basis.
Example 1: A surgeon performs a novel laparoscopic technique to repair a complex stomach perforation not covered by existing CPT codes., A gastroenterologist develops a new endoscopic procedure to treat a rare stomach condition requiring a unique approach not captured by other codes., A surgeon performs a minimally invasive procedure using a new robotic system to remove a stomach tumor in a way not previously described or coded.
* Operative report detailing the procedure performed, including technique, instruments, and complications.* Preoperative and postoperative diagnostic imaging (e.g., endoscopy, CT scan).* Complete patient history and physical examination.* Justification for using an unlisted code, including comparison to similar procedures.
** Accurate and detailed documentation is critical when using unlisted procedure codes.This code should only be used when no other appropriate code is available.Consult with your payer for specific reimbursement policies regarding unlisted procedure codes.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- RVU: Not specified in provided data.RVUs vary by payer and location.
- Global Days : Not specified in provided data; this depends on the specific procedure performed.
- Payment Status: Active
- Modifier TC rule: The application of a TC modifier depends entirely on the specific procedure performed and may or may not be appropriate.
- Fee Schedule : Not available in provided data.Reimbursement rates for unlisted procedures vary widely.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center