2025 CPT code 64755
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Transection or avulsion of vagus nerves limited to the proximal stomach; this includes selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, and supra- or highly selective vagotomy.
Modifiers may apply depending on the specific circumstances of the procedure (e.g., -50 for bilateral procedures, -59 for distinct procedural services). Consult the most current CPT guidelines and payer specific guidelines.
Medical necessity for vagotomy is established when conservative medical management of peptic ulcer disease or other conditions has failed to provide adequate symptom relief and ulcer healing.Documentation must support the failure of less invasive treatments and justify the need for this procedure.
The surgeon performs the procedure after the patient is prepped and anesthetized. This involves a midline abdominal incision, identification and isolation of the anterior left and posterior right vagus nerves, selective division and removal of nerve branches while preserving others, and closure of the incision with a drain if needed.
- Surgery
- Surgical Procedures on the Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System
In simple words: The doctor cuts or removes some of the vagus nerves near the upper part of the stomach to reduce stomach acid production. This helps treat ulcers that haven't responded to other treatments.
This CPT code encompasses the surgical transection or avulsion of the vagus nerves, specifically targeting the branches near the proximal stomach.The procedure aims to reduce gastric acid secretion, often used in the treatment of peptic ulcers when other methods are ineffective.This may involve selective proximal vagotomy, proximal gastric vagotomy, parietal cell vagotomy, or supra- or highly selective vagotomy techniques. The surgeon carefully dissects and severs or removes specific nerve branches while preserving others.The procedure can be performed via open surgery or laparoscopically (for which 43652 is typically used).
Example 1: A 55-year-old male patient with a history of refractory peptic ulcers unresponsive to medical management undergoes a selective proximal vagotomy via open surgery using CPT code 64755., A 40-year-old female patient with severe gastroesophageal reflux disease (GERD) and intractable peptic ulcers is a candidate for a highly selective vagotomy performed laparoscopically (CPT code 43652 would be used instead of 64755)., A 60-year-old male patient with Zollinger-Ellison syndrome causing severe peptic ulceration requires a parietal cell vagotomy as part of a complex surgical management plan. CPT code 64755 would be applied.
* Preoperative diagnosis clearly indicating the need for vagotomy (e.g., refractory peptic ulcer disease, Zollinger-Ellison syndrome).* Detailed operative notes describing the surgical approach (open or laparoscopic), the specific type of vagotomy performed (selective, proximal, parietal cell, etc.), the number of nerve branches transected or avulsed, and any complications encountered.* Histopathological examination of resected nerve tissue if applicable.* Postoperative course and any complications.* Imaging studies supporting the diagnosis (e.g., endoscopy).
** Always cross-reference with other relevant codes (e.g., 43652 for laparoscopic approach) and payer-specific guidelines to ensure accurate coding and reimbursement.Consider if other procedures were performed during the same surgical session, and code appropriately.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier may not apply to this code, given that it represents the entire procedure.
- Specialties:General Surgery, Gastroenterology
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center