How To Use CPT Code 43775

CPT 43775 is a code for laparoscopic sleeve gastrectomy, a surgical procedure to treat morbid obesity. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 43775.

1. What is CPT 43775?

CPT 43775 is a code used to describe a laparoscopic sleeve gastrectomy procedure. This surgical procedure is performed to treat morbid obesity by reducing the size of the stomach, without rerouting the digestive tract or creating a bypass. The procedure is performed using a laparoscope, which allows the surgeon to view the abdominal area and perform the surgery with minimal incisions.

2. 43775 CPT code description

The official description of CPT code 43775 is: “Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)”.

3. Procedure

The 43775 procedure involves the following steps:

1. The patient is prepped and anesthetized.
2. A small incision is made in the belly button or lower abdomen, and the abdominal cavity is filled with carbon dioxide to lift the abdominal wall away from the internal organs.
3. A laparoscope is inserted through the incision, allowing the surgeon to view the abdominal area using monitors in the operating room.
4. A lengthwise incision is made from the top outer portion of the stomach to the distal antrum, and about 60% of the stomach’s bulk is removed.
5. The remaining stomach is sutured in line with the opening from the esophagus to the opening into the duodenum, creating a tube or sleeve-like shape.
6. The pyloric sphincter is preserved, allowing for a more natural transit of food from the stomach to the duodenum and avoiding dumping syndrome.
7. The abdomen is deflated, the trocars are removed, and the incisions are closed with staples, stitches, or special glue.

4. Qualifying circumstances

Patients eligible to receive CPT code 43775 services are those diagnosed with morbid obesity and have not responded to non-surgical weight loss treatments, such as diet, exercise, and medication. Morbid obesity is typically defined as having 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. The procedure may also be performed as the first stage of two procedures to treat morbid obesity in high-risk patients.

5. When to use CPT code 43775

It is appropriate to bill the 43775 CPT code when a laparoscopic sleeve gastrectomy is performed to treat morbid obesity in eligible patients, as described in the qualifying circumstances section. The procedure should be performed by a qualified surgeon with experience in bariatric surgery.

6. Documentation requirements

To support a claim for CPT 43775, the following information should be documented:

• Patient’s medical history, including previous non-surgical weight loss attempts and obesity-related health conditions.
• Physical examination findings, including BMI and any obesity-related complications.
• Preoperative diagnostic tests, such as blood work, imaging studies, and consultations with other specialists, if applicable.
• Operative report, detailing the surgical procedure, including the use of a laparoscope, the incisions made, the amount of stomach removed, and the closure technique.
• Postoperative care plan, including follow-up appointments, dietary recommendations, and any necessary medications or therapies.

7. Billing guidelines

When billing for CPT code 43775, it is important to follow payer-specific guidelines and rules. Some payers may require preauthorization or have specific coverage criteria for bariatric surgery. Additionally, it is essential to accurately code any related diagnoses using the appropriate ICD-10 codes. Be sure to review the patient’s insurance policy for any exclusions or limitations related to bariatric surgery.

8. Historical information

CPT 43775 was added to the Current Procedural Terminology system on January 1, 2010. In 2017, it was added to the Medicare Inpatient Only (IPO) list.

9. Similar codes to CPT 43775

Five similar codes to CPT 43775 and how they differ are:

• CPT 43644: This code is for a laparoscopic Roux-en-Y gastric bypass with a roux limb of 150 cm or less for morbid obesity.
• CPT 43645: This code is for a laparoscopic gastric bypass and small intestine reconstruction to limit absorption or for a roux limb greater than 150 cm.
• CPT 43846: This code is for an open gastric restrictive procedure, without gastric bypass, for morbid obesity, other than vertical-banded gastroplasty.
• CPT 43847: This code is for an open gastric bypass with small intestine reconstruction to limit absorption or for a roux limb greater than 150 cm.
• CPT 43842: This code is for a vertical-banded gastroplasty for morbid obesity.

10. Examples

Here are 10 detailed examples of CPT code 43775 procedures:

1. A 45-year-old female with a BMI of 42 and type 2 diabetes undergoes a laparoscopic sleeve gastrectomy to treat her morbid obesity and improve her diabetes management.
2. A 38-year-old male with a BMI of 40 and hypertension undergoes a laparoscopic sleeve gastrectomy to reduce his weight and lower his blood pressure.
3. A 50-year-old female with a BMI of 35 and severe sleep apnea undergoes a laparoscopic sleeve gastrectomy to alleviate her sleep apnea symptoms and improve her overall health.
4. A 55-year-old male with a BMI of 45 and a history of failed non-surgical weight loss attempts undergoes a laparoscopic sleeve gastrectomy as the first stage of a two-stage bariatric surgery plan.
5. A 48-year-old female with a BMI of 41 and obesity-related joint pain undergoes a laparoscopic sleeve gastrectomy to reduce her weight and improve her joint function.
6. A 52-year-old male with a BMI of 39 and obesity-related liver disease undergoes a laparoscopic sleeve gastrectomy to reduce his weight and improve his liver function.
7. A 47-year-old female with a BMI of 37 and obesity-related infertility undergoes a laparoscopic sleeve gastrectomy to improve her chances of conception.
8. A 43-year-old male with a BMI of 44 and obesity-related gastroesophageal reflux disease (GERD) undergoes a laparoscopic sleeve gastrectomy to reduce his weight and alleviate his GERD symptoms.
9. A 49-year-old female with a BMI of 46 and obesity-related depression undergoes a laparoscopic sleeve gastrectomy to improve her mental health and overall well-being.
10. A 51-year-old male with a BMI of 38 and obesity-related cardiovascular disease undergoes a laparoscopic sleeve gastrectomy to reduce his weight and improve his cardiovascular health.