How To Use CPT Code 43644

CPT 43644 is a code for laparoscopic gastric restrictive procedures with gastric bypass and Roux-en-Y gastroenterostomy. This article will cover the description, procedure, qualifying circumstances, when to use, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 43644.

1. What is CPT 43644?

CPT 43644 is a medical code used to describe a specific type of laparoscopic gastric restrictive procedure that involves gastric bypass and Roux-en-Y gastroenterostomy. This procedure is typically performed to treat morbid obesity by surgically reducing the size of the stomach and creating a connection between the stomach and the jejunum using a laparoscopic technique.

2. 43644 CPT code description

The official description of CPT code 43644 is: Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less).

3. Procedure

The 43644 procedure involves the following steps:

  1. The patient is appropriately prepped and anesthetized.
  2. The provider makes several laparoscopic incisions and inserts a scope and surgical instruments.
  3. The abdomen is inflated with carbon dioxide for better exposure.
  4. The provider divides the small bowel below the lower stomach outlet and rearranges it into a Y formation so that the food flows out from the small upper stomach pouch into a Roux limb.
  5. Alternatively, the provider places the Y intersection near the upper, or proximal, end of the small bowel.
  6. The provider constructs the Roux limb, preserving most of the small bowel for absorption of nutrients.
  7. The provider checks for bleeding, removes any instruments, and finally closes the incision in the abdomen.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 43644 services are typically those diagnosed with morbid obesity and have not responded to conservative weight loss treatments such as diet, exercise, and medication. The procedure is generally recommended for patients with a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as type 2 diabetes, hypertension, or sleep apnea.

5. When to use CPT code 43644

It is appropriate to bill the 43644 CPT code when a provider performs a laparoscopic gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy for the treatment of morbid obesity. The procedure should be medically necessary and supported by proper documentation, including the patient’s BMI, obesity-related health conditions, and failed attempts at conservative weight loss treatments.

6. Documentation requirements

To support a claim for CPT 43644, the following information should be documented:

  • Patient’s medical history, including obesity-related health conditions and previous weight loss attempts.
  • Physical examination findings, including BMI measurement.
  • Indication for the procedure, such as morbid obesity and failure of conservative treatments.
  • Details of the procedure performed, including the type of gastric restrictive procedure, gastric bypass, and Roux-en-Y gastroenterostomy.
  • Postoperative care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 43644, it is essential to follow the specific guidelines and rules set by the payer. Some payers may not cover operative procedures for morbid obesity, so it is crucial to verify coverage before submitting a claim. Additionally, certain modifiers may be required when reporting CPT 43644 in conjunction with other codes or when an esophagogastroduodenoscopy (EGD) is performed for a separate condition.

8. Historical information

CPT 43644 was added to the Current Procedural Terminology system on January 1, 2005. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Similar codes to CPT 43644

Five similar codes to CPT 43644 and how they differentiate are:

  • CPT 43645: This code is used for laparoscopic gastric bypass with Roux-en-Y gastroenterostomy and a roux limb greater than 150 cm.
  • CPT 43846: This code is for an open gastric bypass procedure with Roux-en-Y gastroenterostomy and small intestine reconstruction to limit absorption.
  • CPT 43847: This code is for an open gastric bypass with Roux-en-Y gastroenterostomy and small intestine reconstruction to limit absorption or for a roux limb greater than 150 cm.
  • CPT 43775: This code is for a laparoscopic longitudinal gastrectomy or sleeve gastrectomy.
  • CPT 43770: This code is for laparoscopic placement of an adjustable gastric restrictive device.

10. Examples

Here are 10 detailed examples of CPT code 43644 procedures:

  1. A 45-year-old female with a BMI of 42 and type 2 diabetes undergoes a laparoscopic gastric bypass with Roux-en-Y gastroenterostomy.
  2. A 38-year-old male with a BMI of 40 and hypertension undergoes a laparoscopic gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy.
  3. A 50-year-old female with a BMI of 45 and sleep apnea undergoes a laparoscopic gastric bypass with Roux-en-Y gastroenterostomy.
  4. A 35-year-old male with a BMI of 37 and obesity-related joint pain undergoes a laparoscopic gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy.
  5. A 48-year-old female with a BMI of 41 and type 2 diabetes undergoes a laparoscopic gastric bypass with Roux-en-Y gastroenterostomy.
  6. A 55-year-old male with a BMI of 43 and hypertension undergoes a laparoscopic gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy.
  7. A 40-year-old female with a BMI of 39 and obesity-related cardiovascular disease undergoes a laparoscopic gastric bypass with Roux-en-Y gastroenterostomy.
  8. A 47-year-old male with a BMI of 44 and sleep apnea undergoes a laparoscopic gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy.
  9. A 52-year-old female with a BMI of 46 and type 2 diabetes undergoes a laparoscopic gastric bypass with Roux-en-Y gastroenterostomy.
  10. A 36-year-old male with a BMI of 38 and obesity-related joint pain undergoes a laparoscopic gastric restrictive procedure with gastric bypass and Roux-en-Y gastroenterostomy.

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