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The CPT® Code 43645 refers to a laparoscopic surgical procedure designed to address morbid obesity through a gastric restrictive approach combined with gastric bypass and small intestine reconstruction aimed at limiting nutrient absorption. This procedure is typically indicated for patients who have not achieved significant weight loss through non-surgical means and are at risk for obesity-related health complications. The process begins with the creation of small incisions in the upper abdomen, allowing for the insertion of a trocar and the establishment of pneumoperitoneum, which is the introduction of gas into the abdominal cavity to create a working space for the surgeon. A laparoscope, a specialized camera, is then introduced to provide visualization of the internal structures. Additional incisions are made to facilitate the insertion of surgical instruments necessary for the procedure. During the operation, the liver is retracted to expose the upper stomach, and the gastroesophageal junction is identified. The gastrohepatic ligament is incised, creating a tunnel behind the stomach. An endoscopic linear stapler is utilized to transect the stomach, forming a small gastric pouch that restricts food intake. The procedure continues with the identification of the ligament of Treitz, where the jejunum is transected. A Roux-en-Y gastroenterostomy is performed, which involves creating a bypass that allows food to flow from the gastric pouch into the jejunum, effectively bypassing a significant portion of the small intestine. In the context of CPT® Code 43645, the procedure includes the reconstruction of the small intestine to further limit absorption, which is a critical aspect of promoting weight loss through malabsorption. This may involve the creation of a Roux limb that exceeds 150 cm, with options for a short biliopancreatic limb or a longer limb that is anastomosed distal to the ileocecal valve. Overall, this complex surgical intervention combines both restrictive and malabsorptive techniques to facilitate significant weight loss and improve the health outcomes of patients suffering from severe obesity.
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The procedure associated with CPT® Code 43645 is indicated for patients suffering from morbid obesity, which is characterized by an excessive accumulation of body fat that poses significant health risks. The following conditions may warrant the performance of this surgical intervention:
The surgical procedure for CPT® Code 43645 involves several critical steps, each designed to effectively reduce stomach size and limit nutrient absorption:
After the completion of the procedure, patients typically require monitoring in a recovery area to ensure stable vital signs and manage any immediate postoperative discomfort. Post-procedure care may include dietary modifications, where patients are advised to follow a specific diet to facilitate healing and adaptation to the new gastric pouch. Patients are often instructed to gradually transition from a liquid diet to soft foods and eventually to solid foods as tolerated. Follow-up appointments are essential to monitor weight loss progress, nutritional status, and any potential complications. Additionally, patients may need to take vitamin and mineral supplements to prevent deficiencies due to the malabsorptive nature of the procedure. Overall, the recovery process and adherence to dietary guidelines are critical for achieving the desired outcomes of weight loss and improved health.
| Short Descr | LAP GASTR BYPASS INCL SMLL I | Medium Descr | LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ | Long Descr | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption | 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 | 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). | 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. | 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). | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | 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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