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An open revision of a gastric restrictive procedure for morbid obesity, as described by CPT® Code 43848, involves surgical intervention to correct or modify a previously performed gastric procedure that has not achieved the desired outcomes. This type of revision is necessary when the initial gastric restrictive procedure fails, which can occur due to various reasons such as weight regain, mechanical complications, or patient intolerance to the restriction imposed by the original procedure. The specific type of revision performed is contingent upon the nature of the original gastric procedure and the underlying reason for its failure. Commonly, the revision may involve procedures such as a mini-gastric bypass or a Roux-en-Y gastric bypass. During the operation, an incision is made in the abdomen to access the stomach, which is then carefully dissected free from surrounding tissues. Any previously implanted gastric restrictive devices, such as a vertical gastric band, are removed to facilitate the revision. The surgical approach aims to create a new configuration of the stomach and its connection to the small intestine, thereby altering the digestive process to promote weight loss and improve health outcomes for patients suffering from morbid obesity.
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The procedure is indicated for patients who have undergone a previous gastric restrictive procedure for morbid obesity and are experiencing complications or inadequate weight loss. The specific indications include:
The open revision of a gastric restrictive procedure involves several critical steps, which are detailed as follows:
After the completion of the revision procedure, patients typically require monitoring in a recovery area to ensure stable vital signs and manage any immediate postoperative discomfort. Post-procedure care may include dietary modifications, gradual reintroduction of food, and close follow-up with healthcare providers to monitor weight loss progress and any potential complications. Patients are advised to adhere to a structured follow-up plan to assess the effectiveness of the revision and to ensure proper healing and adaptation to the new gastric configuration.
| Short Descr | REVISION GASTROPLASTY | Medium Descr | REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE | Long Descr | Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) | 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). | 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). | 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. | 78 | Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.) | 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). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | 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 | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2008-01-01 | Changed | Code description changed. |
| 2006-01-01 | Changed | Code description changed. |
| 1995-01-01 | Added | First appearance in code book in 1995. |
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