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The CPT® Code 43847 refers to a gastric restrictive procedure that includes gastric bypass specifically designed for the treatment of morbid obesity. This procedure is characterized by the combination of gastric restriction and the bypass of a significant portion of the small intestine, which is intended to promote fat malabsorption. The surgical approach typically involves making an upper abdominal midline incision to gain access to the stomach. During the operation, the liver is retracted to expose the upper part of the stomach, allowing the surgeon to identify critical anatomical landmarks such as the gastroesophageal junction. The procedure entails creating a small gastric pouch and performing a Roux-en-Y gastroenterostomy, which is a technique that connects the newly formed pouch to the small intestine. The unique aspect of this procedure is the reconstruction of the small intestine to limit nutrient absorption, which is achieved by creating a Roux limb that exceeds 150 cm in length. This surgical intervention is aimed at significantly reducing the volume of food intake and altering the digestive process to assist patients in achieving substantial weight loss and improving obesity-related health conditions.
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The gastric restrictive procedure with gastric bypass for morbid obesity, as described by CPT® Code 43847, is indicated for patients who are suffering from morbid obesity. This condition is typically characterized by a body mass index (BMI) of 40 or greater, or a BMI of 35 or greater with obesity-related comorbidities such as type 2 diabetes, hypertension, or sleep apnea. The procedure is performed to facilitate significant weight loss and to improve or resolve obesity-related health issues.
The procedure begins with the surgeon making an upper abdominal midline incision to access the stomach. The liver is then retracted to expose the upper aspect of the stomach, allowing for the identification of the gastroesophageal junction. Following this, the gastrohepatic ligament is incised at the edge of the lesser curvature of the stomach, and a tunnel is created behind the upper aspect of the stomach. A linear stapler is utilized to transect the stomach, resulting in the formation of a small gastric pouch in the proximal aspect of the stomach. The ligament of Treitz is identified, and the jejunum is transected a few centimeters distal to this point. Subsequently, a Roux-en-Y gastroenterostomy is performed, where the distal Roux-en-Y 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. The jejunum is anastomosed to the small gastric pouch using a side-to-side technique. The proximal Roux limb is measured to ensure it does not exceed 150 cm before being anastomosed to the jejunum. In the case of CPT® Code 43847, small intestine reconstruction is performed to limit absorption, which involves creating a Roux limb that is greater than 150 cm. The surgeon may opt to create a short biliopancreatic limb measuring between 20-90 cm, paired with a very long Roux limb exceeding 150 cm, or a very long limb that is anastomosed distal to the ileocecal valve. Once all anastomoses are completed, drains are placed, and the abdominal incision is closed.
After the completion of the gastric restrictive procedure with gastric bypass, patients are typically monitored for any immediate postoperative complications. Post-procedure care may include pain management, monitoring for signs of infection, and ensuring proper hydration. Patients are often advised to follow a specific diet that gradually progresses from clear liquids to solid foods as they recover. Follow-up appointments are essential to monitor weight loss progress and nutritional status, as well as to manage any potential complications that may arise from the surgery. It is crucial for patients to adhere to the recommended lifestyle changes and nutritional guidelines to achieve optimal outcomes from the procedure.
| Short Descr | GASTRIC BYPASS INCL SMALL I | Medium Descr | GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ | Long Descr | Gastric restrictive procedure, with gastric bypass for morbid obesity; with 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 |
| 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). | 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 |
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| 2002-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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