General Surgery Coding Alert

Question: The surgeon performed an open gastric bypass procedure in which he described partitioning the stomach with staples. The note also describes cutting the small bowel and anastomosing the distal end of the intestine to the proximal stomach pouch, creating a 140 cm limb. The note further describes anastomosing the “unused” cut end of the small intestine to a more distal location of the small bowel. Please help with the code selection for this procedure.

Arkansas Subscriber

Answer: You should code this procedure as 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy).

Even though you don’t state that the op note identifies the name of this surgery, what you’ve described is an open “Roux-en-Y” procedure. In this surgery, the physician restricts the size of the stomach, not by removing a portion of it, but by closing off a portion of it with sutures.

Additionally, the surgeon 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.

Note limb length: If the op note had noted an intestinal limb greater than 150 cm, you should not use this code. Instead, you would report the procedure as 43847 (…with small intestine reconstruction to limit absorption).

Lap is different: If the surgeon had described this as a laparoscopic rather than an open surgery, your best code choice would be 43644 (Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [roux limb 150 cm or less]).