How To Use CPT Code 43775

CPT 43775 refers to the laparoscopic surgical procedure known as longitudinal gastrectomy, commonly referred to as sleeve gastrectomy. This procedure is primarily performed to treat morbid obesity by significantly reducing the size of the stomach. The technique involves the removal of a substantial portion of the stomach, leaving a tubular structure that allows for normal digestion without rerouting the digestive tract. This method is particularly beneficial for high-risk patients and can be performed as a standalone procedure or as part of a staged approach to weight loss surgery.

1. What is CPT code 43775?

CPT code 43775 represents a laparoscopic surgical procedure aimed at treating morbid obesity through a gastric restrictive approach. The procedure involves the removal of approximately 60% of the stomach, creating a long, sleeve-like structure that limits food intake while preserving the pyloric sphincter. This preservation allows for a more natural progression of food from the stomach to the duodenum, minimizing the risk of complications such as dumping syndrome, which can occur with other types of gastric surgeries. The laparoscopic technique is favored for its minimally invasive nature, leading to reduced recovery times and less postoperative pain compared to open surgical methods.

2. Qualifying Circumstances

This CPT code can be utilized in specific clinical scenarios where patients are diagnosed with morbid obesity, defined as having a body mass index (BMI) of 40 or greater, or being 100 pounds or more overweight. The procedure is appropriate for patients who have not achieved significant weight loss through non-surgical means and who are at high risk for obesity-related health complications. However, it is essential to note that not all insurance providers cover this procedure, and prior authorization may be required. Additionally, the use of this code is inappropriate for patients who do not meet the criteria for morbid obesity or those who have contraindications for surgery.

3. When To Use CPT 43775

CPT code 43775 is used when a provider performs a laparoscopic longitudinal gastrectomy as a treatment for morbid obesity. It is important to document the patient’s medical history, including previous weight loss attempts and any obesity-related health issues, to justify the procedure. This code should not be used in conjunction with codes for other gastric bypass procedures, such as the laparoscopic Roux-en-Y gastric bypass (CPT 43644 or 43645), as these represent different surgical techniques. Providers must ensure that the patient is adequately prepared for surgery and that all necessary preoperative evaluations have been completed.

4. Official Description of CPT 43775

Official Descriptor: Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy).

5. Clinical Application

The clinical application of CPT code 43775 is centered around the treatment of morbid obesity through a surgical approach that reduces stomach size. This procedure is crucial for patients who have not responded to conservative weight loss methods and are at risk for serious health complications, such as diabetes, hypertension, and sleep apnea. By limiting the amount of food the stomach can hold, the procedure promotes weight loss and can lead to significant improvements in overall health and quality of life.

5.1 Provider Responsibilities

During the procedure, the provider begins by ensuring the patient is properly anesthetized and positioned. A small incision is made, typically at the belly button, and carbon dioxide is introduced into the abdominal cavity to create space for visualization. The laparoscope is inserted, allowing the provider to view the internal structures on a monitor. The provider then makes a longitudinal incision along the stomach, removing a significant portion of the organ. After reshaping the stomach into a sleeve, the provider sutures the remaining stomach to maintain its connection to the esophagus and duodenum. Finally, the abdomen is deflated, and the incisions are closed using appropriate techniques.

5.2 Unique Challenges

One of the unique challenges associated with this procedure is the need for precise surgical technique to avoid complications such as leaks at the staple line or bleeding. Additionally, the provider must be adept at managing the laparoscopic instruments and navigating the abdominal cavity without causing damage to surrounding organs. Postoperative care is also critical, as patients may experience complications such as nausea or infection, necessitating careful monitoring and follow-up.

5.3 Pre-Procedure Preparations

Before the procedure, the provider must conduct a thorough evaluation of the patient’s medical history, including previous weight loss attempts and any comorbid conditions. Preoperative assessments may include laboratory tests, imaging studies, and consultations with nutritionists or psychologists to ensure the patient is mentally and physically prepared for surgery. Patients are typically required to follow a specific diet leading up to the procedure to reduce liver size and facilitate easier access during surgery.

5.4 Post-Procedure Considerations

After the procedure, patients require close monitoring for any signs of complications, such as leakage from the staple line or infection. Follow-up appointments are essential to assess weight loss progress and nutritional intake. Patients are often advised to adhere to a specific diet and may need to take vitamin and mineral supplements to prevent deficiencies due to the reduced size of the stomach and altered digestion.

6. Relevant Terminology

Antrum: The lower part of the stomach that connects to the pyloric channel.

Distal: Referring to a position away from the center of the body or the point of attachment.

Duodenum: The first section of the small intestine, where a significant amount of digestion occurs.

Esophagogastric junction: The area where the esophagus meets the stomach, identifiable by changes in the tissue lining.

Gastrectomy: The surgical removal of part or all of the stomach.

Gastric bypass: A procedure that creates a new pathway for food to bypass a portion of the stomach.

Gastric restrictive procedure: A surgery designed to limit food intake by reducing stomach size.

Ileum: The final section of the small intestine, following the jejunum.

Implantation: The surgical placement of devices or tissues within the body.

Laparoscopic longitudinal gastrectomy: A minimally invasive surgical technique to remove a portion of the stomach.

Laparoscopy: A surgical technique involving small incisions and the use of a camera to guide the procedure.

Malabsorption: A condition where the body fails to absorb nutrients effectively.

Morbid obesity: A severe level of obesity that poses significant health risks.

Pulse generator: A device that sends electrical signals to stimulate nerves.

Vagus nerve blocking neurostimulator electrode array: A device used to interrupt signals from the vagus nerve to aid in weight loss.

Vertical banded gastroplasty: A surgical method that creates a small stomach pouch to restrict food intake.

7. Clinical Examples

1. A 45-year-old female patient with a BMI of 42 who has tried multiple diets without success is referred for a laparoscopic sleeve gastrectomy.

2. A 50-year-old male patient with obesity-related diabetes undergoes the procedure to improve his metabolic health.

3. A patient with a history of sleep apnea and a BMI of 39 is evaluated for surgical intervention after failing conservative treatments.

4. A 38-year-old woman with a BMI of 45 is considered for surgery after experiencing joint pain due to her weight.

5. A patient with a BMI of 41 who has developed hypertension is scheduled for a laparoscopic longitudinal gastrectomy.

6. A 60-year-old male patient with a BMI of 44 is referred for surgery after being advised by his physician to lose weight for heart health.

7. A patient with a BMI of 40 who has not lost weight through medication is evaluated for a sleeve gastrectomy.

8. A 55-year-old woman with obesity-related complications is approved for laparoscopic surgery after a thorough evaluation.

9. A patient with a BMI of 43 and a history of failed weight loss attempts is informed about the benefits of sleeve gastrectomy.

10. A 48-year-old male patient with a BMI of 41 is educated on the risks and benefits of laparoscopic longitudinal gastrectomy before surgery.