# Asc question



## EMS7775 (Jun 23, 2009)

My question is about a gastrojejunal bypass with a jejunal feeding tube.  I do not see a code for a gastrojejunal bypass. But I do see one for the jejunal feeding tube. Is there one other than gastric bypass for morbid obesity?


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## ALONNA (Jun 24, 2009)

Hello, 
You could use  43644 for gastric restrictive procedure with gastric bypass with the Gastroenterostomy tube  included.  Here's a description of the different types below with laparoscopic guidance and without. 




	Bariatric surgery 
	CPT Assistant, May 2005 Pages: 3,4   Category: Coding Communication
	Related Information
Note from 3M:
 As of January 1, 2006
Ÿ 43770-43774 have been added to report procedures involved in bariatric surgery


Bariatric Surgery

Three new gastric restrictive surgery codes were added to reflect the rapidly expanding field of bariatric surgery. Codes 43644 and 43645 employ laparoscopic techniques to perform gastric restrictive procedures for morbid obesity, including Roux-en-Y gastric bypass and small bowel reconstruction to limit absorption. The Roux-en-Y gastric bypass procedure is the most frequently performed bariatric procedure in the United States.

43644   Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)

43645   Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption

Code 43845 was added to describe a biliopancreatic diversion with duodenal switch, a surgical treatment for morbid obesity that combines moderate gastric restriction with a mechanism that promotes fat malabsorption and includes duodenal division and pylorus preservation with two reconstructive anastomoses.

43845   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)

For consistency, an editorial revision was made to the existing open Roux-en-Y code 43846 to designate short limb to be 150 cm as specified in the laparoscopic Roux-en-Y gastroenterostomy code 43644.

43846   Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy

In a gastric bypass for morbid obesity (code 43846), the stomach is partitioned with a staple line on the lesser curvature (no band, no gastric transection). A short limb of small bowel (less than 100 cm) is divided and anastomosed to the small upper stomach pouch.

The revision to code 43846 more accurately describes the location of the division of the section of small intestine and reflects the typical current practice for this procedure, which has become the standard of care to perform a longer Roux-en-Y gastroenterostomy (limbs up to 150 cm). This procedure has evolved in order to provide more effective treatment for patients with greater obesity (ie, 225% of ideal body weight or greater). In these patients, a 150 cm proximal Roux-en-Y procedure (long-limb gastric bypass) has been found to increase weight loss to two thirds of excess weight without causing an increase in nutritional complications.





CPT Assistant © Copyright 1990–2009 American Medical Association. All 
Rights Reserved ut

Alonna Owens, CPC-H
alonna.owens@tmh.org


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## EMS7775 (Jun 24, 2009)

*ASC coding*

Thanks, Alonna I was in the ball park.

Ebony


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## ALONNA (Jun 24, 2009)

You are welcome.  Any time you may have a question concerning  ASC surgical coding or APC Reimbursement pleae feel free to E-mail me at alonna.owens@tmh.org




Alonna


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## EMS7775 (Jun 25, 2009)

*Asc ?*

Okay, thanks Alonna I am looking for contacts to help me out.

Ebony Ratcliffe, AS, CPC


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