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The CPT® Code 43845 refers to a complex surgical procedure known as a gastric restrictive procedure with partial gastrectomy, specifically designed to limit nutrient absorption. This procedure is commonly recognized as biliopancreatic diversion with duodenal switch. It involves significant alterations to the gastrointestinal tract to aid in weight loss and manage obesity-related health issues. The procedure begins with a midline abdominal incision, which allows the surgeon to access the stomach and surrounding structures. The stomach is then mobilized, and a longitudinal pouch is created through a staple division that starts at the top of the gastric fundus and extends laterally to the gastroesophageal junction at the angle of His. This step is crucial as it reduces the stomach's capacity, thereby limiting food intake. In this procedure, the lateral aspect of the stomach is removed, while the pyloric sphincter and a small portion of the proximal duodenum are preserved to maintain some normal digestive function. The first portion of the duodenum is carefully mobilized and transected a few centimeters from the pylorus, which is essential for the subsequent steps. The small bowel is also transected at a specific distance from the ileocecal valve, allowing for the creation of a new pathway for food and digestive juices. The distal limb of the small bowel is then sutured to the remaining duodenal segment using an end-to-end technique, which facilitates the flow of digestive contents. Finally, the proximal biliopancreatic limb is connected to the small bowel at a calculated distance from the ileocecal valve, typically between 50 to 100 cm, to optimize nutrient absorption. After the completion of these steps, drains are placed to manage any potential fluid accumulation, and the abdominal incisions are meticulously closed to promote healing.
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The procedure described by CPT® Code 43845 is indicated for patients who are struggling with severe obesity and related comorbidities. The following conditions may warrant the performance of this surgical intervention:
The surgical steps involved in CPT® Code 43845 are as follows:
Post-procedure care for patients undergoing CPT® Code 43845 includes monitoring for complications such as infection, leakage, or bowel obstruction. Patients are typically advised to follow a specific diet to aid in recovery and to gradually reintroduce solid foods. Regular follow-up appointments are essential to monitor weight loss progress and nutritional status, as well as to manage any potential deficiencies that may arise due to the altered absorption capabilities of the gastrointestinal tract. Additionally, patients may require supplementation of vitamins and minerals to ensure adequate nutrition during their recovery and beyond.
| Short Descr | GASTROPLASTY DUODENAL SWITCH | Medium Descr | GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM | Long Descr | Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) | 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 |
| 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). | 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). | 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) | GA | Waiver of liability statement issued as required by payer policy, individual case | 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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| 2005-01-01 | Added | First appearance in code book in 2005. |
| 1992-12-31 | Deleted | Code deleted. |
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