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The CPT® Code 43843 refers to a gastric restrictive procedure performed for the treatment of morbid obesity, specifically utilizing techniques other than vertical-banded gastroplasty. This procedure is designed to create a gastric pouch that limits food intake and promotes a feeling of fullness, thereby assisting in weight loss. Unlike vertical-banded gastroplasty, which involves the placement of a band around the stomach, this code encompasses various other surgical methods aimed at restricting the stomach's capacity without bypassing any part of the gastrointestinal tract. The procedure typically involves a midline abdominal incision to access the stomach, allowing the surgeon to manipulate the stomach's structure to form a smaller pouch. This smaller pouch is crucial for controlling the amount of food that can be consumed at one time, ultimately aiding in weight management for individuals suffering from severe obesity. The focus of this procedure is on creating a restrictive environment within the stomach, which is essential for achieving long-term weight loss and improving overall health outcomes for patients with morbid obesity.
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The gastric restrictive procedure coded as CPT® 43843 is indicated for patients suffering from morbid obesity. This condition is characterized by an excessive accumulation of body fat that presents significant health risks. The procedure is typically considered when other weight loss methods, such as diet and exercise, have failed to produce sustainable results. The primary indications for this procedure include:
The procedure associated with CPT® 43843 involves several key steps to effectively create a gastric pouch and restrict food passage through the stomach. The following procedural steps are typically performed:
After the gastric restrictive procedure coded as CPT® 43843, patients typically require careful monitoring and follow-up care. Post-procedure care may include dietary modifications, such as transitioning to a liquid diet initially, followed by gradual reintroduction of solid foods. Patients are often advised to attend regular follow-up appointments to monitor weight loss progress and nutritional intake. Additionally, education on lifestyle changes, including exercise and healthy eating habits, is essential for achieving long-term success. Potential complications, such as infection or pouch dilation, should be discussed with patients, and they should be informed about signs and symptoms that warrant immediate medical attention. Overall, the post-procedure phase is critical for ensuring optimal recovery and maximizing the benefits of the surgical intervention.
| Short Descr | GASTROPLASTY W/O V-BAND | Medium Descr | GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP | Long Descr | Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty | 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) | 2 - Co-surgeons permitted and no documentation required if the two- specialty requirement is met. | 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 |
| 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. | 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. | 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.) | 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). | GC | This service has been performed in part by a resident under the direction of a teaching physician | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 1993-01-01 | Added | First appearance in code book in 1993. |