CPT® Code 0157T | Case2Code

Code deleted, see 43999

Official Description

Laparotomy, implantation or replacement of gastric stimulation electrodes, lesser curvature (ie, morbid obesity)

Common Language Description

The procedure described by CPT® Code 0157T involves the laparotomy, which is a surgical procedure that opens the abdominal cavity, for the implantation or replacement of gastric stimulation electrodes specifically located at the lesser curvature of the stomach. Gastric stimulation electrodes are devices that help manage morbid obesity by influencing the digestive process. This is achieved through electrical stimulation that reduces food intake and delays gastric emptying, making it a viable treatment option for individuals suffering from severe obesity, particularly those with diabetes. The procedure utilizes a pacing lead system, often referred to as a gastric pacemaker, which consists of a generator device and two stimulation leads. The generator is surgically implanted into a subcutaneous pocket created in the abdominal wall, typically beneath the rib cage, ensuring it is securely positioned. The two lead wires, equipped with electrodes, are then implanted into the muscle wall of the stomach's lesser curvature through an incision made over the stomach. These leads are carefully tunneled under the skin and connected to the generator, allowing for the delivery of electrical stimuli to the stomach. The stimulation can be administered in various forms, including long pulses in continuous cycles or pulse trains that oscillate on and off for short intervals. For procedures involving the open revision or removal of gastric stimulation electrodes, CPT® Code 0158T should be utilized.

1. Indications

The procedure associated with CPT® Code 0157T is indicated for patients suffering from morbid obesity, particularly those who may also have diabetes. The use of gastric stimulation is aimed at reducing food intake and delaying gastric emptying, which can significantly aid in weight management and improve overall health outcomes for these individuals.

Morbid Obesity Patients with a body mass index (BMI) typically greater than 40, or greater than 35 with obesity-related health conditions, may be candidates for this procedure.
Diabetes Individuals with diabetes who are also experiencing morbid obesity may benefit from gastric stimulation as part of their treatment plan.

2. Procedure

The laparotomy procedure for the implantation or replacement of gastric stimulation electrodes involves several critical steps to ensure proper placement and functionality of the device.

Step 1: Anesthesia and Preparation The patient is placed under general anesthesia to ensure comfort and immobility during the procedure. The surgical team prepares the abdominal area by cleaning and draping it to maintain a sterile environment.
Step 2: Laparotomy A surgical incision is made in the abdominal wall to access the stomach. This incision allows the surgeon to visualize and operate on the lesser curvature of the stomach where the electrodes will be implanted.
Step 3: Creation of Subcutaneous Pocket A subcutaneous pocket is created in the abdominal wall beneath the rib cage. This pocket is where the generator device will be implanted, ensuring it is securely positioned and protected.
Step 4: Implantation of Electrodes Two intramuscular lead wires with electrodes are implanted into the muscle wall of the lesser curvature of the stomach. This is done through the open incision, ensuring that the electrodes are properly positioned to deliver effective stimulation.
Step 5: Tunneling of Leads The lead wires are tunneled under the skin from the stomach to the subcutaneous pocket where the generator is located. This step is crucial for connecting the electrodes to the generator while minimizing visible scarring.
Step 6: Connection to Generator The leads are connected to the generator device, which will control the electrical stimulation delivered to the stomach. This connection is vital for the functionality of the gastric pacemaker.
Step 7: Closure Once all components are in place, the surgical incision is closed using sutures or staples, and the area is bandaged appropriately to promote healing.

3. Post-Procedure

After the laparotomy and implantation of gastric stimulation electrodes, patients are typically monitored in a recovery area until they are stable. Post-procedure care includes managing pain, monitoring for any signs of infection, and ensuring the proper functioning of the gastric pacemaker. Patients may be advised on dietary modifications and follow-up appointments to assess the effectiveness of the stimulation and make any necessary adjustments to the device settings. Recovery time may vary, but patients are generally encouraged to gradually resume normal activities as tolerated, following their healthcare provider's recommendations.

Short Descr	OPEN IMPL GAST CURVE ELECTRD
Medium Descr	LAPAROTOMY IMPLTJ/RPLCMT GASTRIC ELECTRODE
Long Descr	Laparotomy, implantation or replacement of gastric stimulation electrodes, lesser curvature (ie, morbid obesity)
Status Code	Carriers Price the Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Discontinued Code
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.
CCS Clinical Classification	94 - Other OR upper GI therapeutic procedures