How To Use CPT Code 43842

CPT 43842 describes a gastric restrictive procedure for morbid obesity known as vertical-banded gastroplasty. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 43842?

CPT 43842 is a code used to describe a gastric restrictive procedure called vertical-banded gastroplasty. This procedure is performed to treat morbid obesity by reducing the size of the stomach. It involves removing the portion of the stomach that produces the hormone ghrelin, which is responsible for the sensation of hunger. The stomach is then closed using staples or sutures to create a small pouch. This restrictive procedure aims to limit the flow of food into the duodenum and decrease the chance of complications associated with gastric bypass procedures, such as intestinal obstruction, anemia, osteoporosis, protein deficiency, and vitamin deficiency.

2. Official Description

The official description of CPT code 43842 is: ‘Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. An incision is made in the abdomen.
3. A vertical row of staples is placed across the upper portion of the stomach to create a small pouch.
4. A restrictive band is placed below the outlet of the pouch to restrict the flow of food into the duodenum.
5. The provider examines the suture line and abdominal area for bleeding and closes the incisions in layers.

4. Qualifying circumstances

CPT 43842 is performed on patients who are morbidly obese, meaning they are so overweight that it endangers their health. The procedure is intended for patients with a body mass index (BMI) equal to or greater than 40 or those who are 100 pounds (45 kg) overweight. It is important to note that operative procedures for morbid obesity may not be covered by Medicare or other payers, so it is essential to check with the payer to determine coverage.

5. When to use CPT code 43842

CPT code 43842 should be used when performing a gastric restrictive procedure known as vertical-banded gastroplasty without gastric bypass for the treatment of morbid obesity. It should not be used for other gastric restrictive procedures or procedures involving gastric bypass. It is important to review the specific documentation and guidelines to ensure accurate coding.

6. Documentation requirements

To support a claim for CPT 43842, the provider must document the following information:

• Patient’s diagnosis of morbid obesity
• Details of the procedure performed, including the creation of a small pouch and placement of a restrictive band
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the provider

7. Billing guidelines

When billing for CPT 43842, it is important to ensure that the procedure performed matches the description of the code. It should be reported as a gastric restrictive procedure without gastric bypass for morbid obesity. It is also important to review payer guidelines and policies regarding coverage and reimbursement for this procedure. It is recommended to use additional codes for postoperative care and management, as well as any other services provided during the same encounter.

8. Historical information

CPT code 43842, vertical-banded gastroplasty, was added to the Current Procedural Terminology system on January 1, 1993. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with a BMI of 42 undergoes vertical-banded gastroplasty to treat their morbid obesity.
2. A provider performs a gastric restrictive procedure without gastric bypass on a patient who is 100 pounds overweight.
3. A morbidly obese individual with a BMI of 45 undergoes vertical-banded gastroplasty to address their weight-related health concerns.
4. A patient with a BMI of 39.5 undergoes vertical-banded gastroplasty to manage their morbid obesity.
5. A provider performs a gastric restrictive procedure without gastric bypass on a patient with a BMI of 41.8 to help them achieve weight loss and improve their overall health.
6. A morbidly obese individual with a BMI of 43 undergoes vertical-banded gastroplasty to address their weight-related health issues.
7. A patient with a BMI of 38.9 undergoes vertical-banded gastroplasty to manage their morbid obesity and improve their quality of life.
8. A provider performs a gastric restrictive procedure without gastric bypass on a patient with a BMI of 44.2 to help them achieve sustainable weight loss.
9. A morbidly obese individual with a BMI of 41 undergoes vertical-banded gastroplasty to address their weight-related health concerns and reduce the risk of associated complications.
10. A patient with a BMI of 40.5 undergoes vertical-banded gastroplasty to manage their morbid obesity and improve their overall well-being.