General Surgery Coding Alert

Question: The surgeon performed a laparoscopic gastric restrictive surgery for obesity by stapling the stomach, then cutting the small intestine and creating a 140 cm limb with anastomosis from the proximal stomach to a more distal location of the small intestine. How should we code this?

Tennessee Subscriber

Answer: The correct code would be 43644 (Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)).

This is a Roux-en-Y procedure in which the surgeon restricts the size of the stomach by closing off, not removing, a portion of the stomach. The surgeon then creates a gastric “detour” so that as the food travels from the proximal stomach pouch through the shortened intestinal limb, it bypasses the distal stomach and jejunal limb. The entire process serves to restrict food intake and absorption due to a smaller stomach and shorter intestine.

The limb length is important for coding this correctly. If the surgeon documents a limb greater than 150 cm, you should turn to 43645 (… with gastric bypass and small intestine reconstruction to limit absorption) according to CPT^® guidelines, even though the code descriptor doesn’t mention Roux-en-Y.

Open: For an open Roux-en-Y, turn to codes 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy) or 43847 (…with small intestine reconstruction to limit absorption) for a limb longer than 150 cm.