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The CPT® Code 43644 refers to a laparoscopic surgical procedure designed specifically for the treatment of morbid obesity. This procedure involves a gastric restrictive technique combined with a gastric bypass and a Roux-en-Y gastroenterostomy, where the length of the Roux limb is 150 cm or less. The process begins with the creation of a small portal incision in the upper abdomen, through which a trocar is inserted to establish pneumoperitoneum, allowing for the introduction of a laparoscope. Additional portal incisions are made to facilitate the insertion of surgical instruments necessary for the procedure. The surgeon then retracts the liver to expose the upper part of the stomach, identifying key anatomical landmarks such as the gastroesophageal junction. The gastrohepatic ligament is incised to create a tunnel behind the stomach, and an endoscopic linear stapler is employed to transect the stomach, forming a small gastric pouch at its proximal end. Following this, the ligament of Treitz is located, and the jejunum is transected a few centimeters distal to this landmark. The Roux-en-Y gastroenterostomy is performed by mobilizing the distal Roux limb and bringing it up to the newly created gastric pouch through a tunnel in the transverse mesocolon. The mesenteric defect is then closed around the distal Roux limb, and the jejunum is anastomosed to the small gastric pouch using a side-to-side technique. The proximal Roux limb is carefully measured to ensure it does not exceed 150 cm before being anastomosed to the jejunum. This procedure effectively combines gastric restriction with the bypass of a significant portion of the small intestine, promoting fat malabsorption and aiding in weight loss for patients suffering from severe obesity.
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The laparoscopic surgical procedure described by CPT® Code 43644 is indicated for patients suffering from morbid obesity. This condition is characterized by an excessive accumulation of body fat that presents a significant risk to health. The procedure is typically recommended for individuals who have not achieved sustainable weight loss through non-surgical methods, such as diet and exercise, and who may have obesity-related comorbidities that could be improved through surgical intervention.
The procedure begins with the creation of a small portal incision in the upper abdomen, where a trocar is inserted to establish pneumoperitoneum. This step is crucial as it allows for the introduction of the laparoscope, which provides visualization of the surgical field. Following this, several additional portal incisions are made in the upper abdomen to facilitate the insertion of various surgical instruments required for the operation. The surgeon then retracts the liver to expose the upper aspect of the stomach, carefully identifying the gastroesophageal junction, which is a critical landmark for the subsequent steps.
After the completion of the laparoscopic gastric restrictive procedure with gastric bypass, patients are typically monitored in a recovery area for any immediate postoperative complications. Post-procedure care includes managing pain, monitoring vital signs, and ensuring the patient is stable before discharge. Patients are usually advised to follow a specific diet plan that gradually progresses from clear liquids to solid foods over several weeks. Follow-up appointments are essential to monitor weight loss progress, nutritional status, and any potential complications. Additionally, patients may require nutritional counseling to ensure they receive adequate vitamins and minerals, as the procedure alters the digestive process and can affect nutrient absorption.
| Short Descr | LAP GASTRIC BYPASS/ROUX-EN-Y | Medium Descr | LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM | Long Descr | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard 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) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 244 - Gastric bypass and volume reduction |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GC | This service has been performed in part by a resident under the direction of a teaching physician | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 58 | Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2005-01-01 | Added | First appearance in code book in 2005. |
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