2025 CPT code 64760
(Active) Effective Date: N/A Revision Date: N/A Surgery - Surgical Procedures on the Nervous System Surgery Feed
Transection or avulsion of the vagus nerve (vagotomy), abdominal.
Modifiers may apply depending on the specific circumstances of the procedure (e.g., 51 for multiple procedures, 22 for increased procedural service, 58 for staged procedures).
The procedure is medically necessary when conservative medical management of peptic ulcers or other conditions associated with excessive gastric acid secretion has failed. Documentation must show the attempts of medical management and their ineffectiveness, indicating the necessity of surgical intervention.
The surgeon is responsible for all aspects of the procedure, including pre-operative planning, intraoperative technique, and postoperative care.This includes careful dissection to avoid damage to surrounding structures.
In simple words: The surgeon cuts or removes part of the vagus nerve in the abdomen to decrease stomach acid production, helping to heal ulcers when other treatments haven't worked. This involves an incision in the abdomen, careful work around the liver and spleen, and then cutting the specific nerve branches before closing the incision.
This procedure involves the transection or avulsion of one or more branches of the vagus nerve through an abdominal approach.The goal is to reduce gastric acid secretion when other methods have failed to treat ulcers.The procedure begins with a midline abdominal incision, followed by mobilization and retraction of the liver and protection of the spleen.The surgeon then incises the tissue overlying the esophagus, mobilizes and loops the esophagus to identify and excise the anterior left and posterior right vagus nerves, along with smaller nerve trunks.The incision is closed with a drain inserted.
Example 1: A patient with severe, refractory peptic ulcers unresponsive to medical management undergoes a selective vagotomy to reduce gastric acid secretion., A patient presents with Zollinger-Ellison syndrome, a condition characterized by excessive gastric acid secretion.A truncal vagotomy is performed to control acid production and alleviate symptoms., In a case of intractable gastric hyperacidity causing severe complications, a total abdominal vagotomy is undertaken to reduce acid secretion.
Pre-operative:Detailed history and physical exam, including documentation of failed medical management, endoscopic findings, and assessment of surgical risk.Intra-operative:Operative report detailing the technique used (selective, truncal, or total vagotomy), the number of nerve branches resected, any complications encountered, and the amount of bleeding.Post-operative:Progress notes documenting the patient's recovery, assessment for complications (e.g., bleeding, infection, dumping syndrome), and any post-operative interventions.
** This code encompasses different types of vagotomies (selective, truncal, total), and the specific type performed should be clearly documented in the operative report.The approach (open or laparoscopic) is also important to consider as this may influence coding.
- Revenue Code: P1G (MAJOR PROCEDURE - OTHER)
- Payment Status: Active
- Specialties:Surgery (General Surgery)
- Place of Service:Inpatient Hospital, Ambulatory Surgical Center