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The CPT® Code 43846 refers to a gastric restrictive procedure specifically designed for the treatment of morbid obesity. This procedure involves a gastric bypass technique known as Roux-en-Y gastroenterostomy, characterized by a short limb measuring 150 cm or less. The surgical approach begins with an upper abdominal midline incision, which allows access to the stomach. During the operation, the liver is retracted to expose the upper part of the stomach, and the gastroesophageal junction is identified to facilitate the subsequent steps. The gastrohepatic ligament is incised at the lesser curvature of the stomach, creating a tunnel behind the upper stomach. A linear stapler is then employed to transect the stomach, resulting in the formation of a small gastric pouch at the proximal end of the stomach. Following this, the ligament of Treitz is located, and the jejunum is transected a few centimeters distal to this landmark. The procedure continues with the creation of the Roux-en-Y gastroenterostomy, where the distal Roux limb is mobilized and brought up to the newly formed gastric pouch through a tunnel in the transverse mesocolon. The mesenteric defect is subsequently closed around the distal Roux limb. The jejunum is then anastomosed to the small gastric pouch using a side-to-side technique, ensuring that the proximal Roux limb does not exceed the specified length of 150 cm before it is anastomosed to the jejunum. This surgical intervention effectively combines gastric restriction with the bypass of a significant portion of the small intestine, promoting fat malabsorption and aiding in weight loss for individuals suffering from morbid obesity.
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The gastric restrictive procedure with gastric bypass for morbid obesity, as described by CPT® Code 43846, is indicated for patients who are classified as morbidly obese. This classification typically includes individuals with a body mass index (BMI) of 40 or greater, or those with a BMI of 35 or greater who also have obesity-related comorbid conditions such as type 2 diabetes, hypertension, or sleep apnea. The procedure aims to facilitate significant weight loss and improve overall health by reducing the stomach's capacity and altering the digestive process.
The procedure begins with the creation of an upper abdominal midline incision, which provides access to the stomach. The surgeon retracts the liver to expose the upper aspect of the stomach, allowing for the identification of the gastroesophageal junction. The gastrohepatic ligament is then incised at the edge of the lesser curvature of the stomach, and a tunnel is created behind the upper aspect of the stomach to facilitate further surgical steps. A linear stapler is utilized to transect the stomach, resulting in the formation of a small gastric pouch at the proximal end of the stomach. Next, the ligament of Treitz is identified, and the jejunum is transected a few centimeters distal to this point. Following this, the Roux-en-Y gastroenterostomy is performed, where the distal Roux limb is mobilized and brought up to the gastric pouch through a tunnel in the transverse mesocolon. The mesenteric defect is then closed around the distal Roux limb to secure it in place. The jejunum is anastomosed to the small gastric pouch using a side-to-side technique, ensuring that the proximal Roux limb is measured to confirm it does not exceed 150 cm in length. Once the anastomosis is completed, the proximal Roux limb is then anastomosed to the jejunum, finalizing the bypass configuration. Throughout the procedure, drains are placed as necessary, and the abdominal incision is subsequently closed to complete the operation.
After the completion of the 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. Patients may be placed on a specific diet that gradually progresses from clear liquids to soft foods, and eventually to a regular diet as tolerated. Follow-up appointments are essential to monitor weight loss progress, nutritional status, and any potential complications. Patients are also advised on the importance of vitamin and mineral supplementation to prevent deficiencies due to altered absorption. Overall, the recovery process may vary among individuals, but adherence to postoperative guidelines is crucial for achieving optimal outcomes.
| Short Descr | GASTRIC BYPASS FOR OBESITY | Medium Descr | GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< | Long Descr | Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy | 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 |
| 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. | 55 | Postoperative management only: when 1 physician or other qualified health care professional performed the postoperative management and another performed the surgical procedure, the postoperative component may be identified by adding modifier 55 to the usual procedure number. | 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). | 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 | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2005-01-01 | Changed | Code description changed. |
| 2001-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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