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Laparoscopic implantation or replacement of gastric neurostimulator electrodes within the antrum of the stomach is a surgical procedure performed to address medically refractory gastroparesis, a condition where the stomach cannot empty itself of food in a normal fashion. This procedure is commonly referred to as the placement of a gastric pacemaker. During the operation, a neurostimulator or generator is implanted into a subcutaneous pocket that is created in the abdominal wall, typically beneath the rib cage. The procedure involves the insertion of two intramuscular lead wires equipped with electrodes into the muscle wall of the stomach antrum. These electrodes are designed to deliver continuous high-frequency, low-energy electrical stimulation to the nerves of the lower stomach. The primary purpose of this electrical stimulation is to promote stomach contractions, which can significantly alleviate symptoms associated with gastroparesis, such as severe vomiting, nausea, and other gastrointestinal complications. For the initial implantation or replacement of these gastric neurostimulator electrodes via laparoscope, the appropriate code to use is 43647. In cases where there is a need for revision or removal of previously placed gastric neurostimulator electrodes, the code 43648 should be utilized.
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The laparoscopic implantation or replacement of gastric neurostimulator electrodes is indicated for patients suffering from medically refractory gastroparesis. This condition is characterized by delayed gastric emptying, which can lead to severe symptoms that significantly impact the patient's quality of life. The procedure is typically considered when other treatment options have failed to provide adequate relief from symptoms such as:
The procedure for laparoscopic implantation or replacement of gastric neurostimulator electrodes involves several key steps, which are detailed below:
Following the laparoscopic implantation or replacement of gastric neurostimulator electrodes, patients are typically monitored in a recovery area for a short period. Post-procedure care may include pain management, instructions for activity restrictions, and guidance on wound care. Patients are often advised to gradually resume normal activities and to follow up with their healthcare provider to assess the effectiveness of the neurostimulator in alleviating symptoms of gastroparesis. It is important for patients to report any unusual symptoms or complications, such as infection or device malfunction, to their healthcare provider promptly.
| Short Descr | LAP IMPL ELECTRODE ANTRUM | Medium Descr | LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM | Long Descr | Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum | Status Code | Carriers Price the Code | Global Days | YYY - Carrier Determines Whether Global Concept Applies | 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 | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 94 - Other OR upper GI therapeutic procedures |
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) |
| 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). | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure 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. | 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. | 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.) | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CR | Catastrophe/disaster related | GC | This service has been performed in part by a resident under the direction of a teaching physician | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure |
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Notes
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| 2024-01-01 | Changed | Guideline information changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2007-01-01 | Added | First appearance in code book in 2007. |
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