When all else fails and the weight doesn’t come off, a patient may choose to have a procedure done to limit the amount of food the stomach can hold. This coding exercise involves the coding of laparoscopic gastric banding procedures. See if you can assign the correct CPT code and then check it against the answer and rationale provided.
Question: A 47-year-old female patient with a body mass index of 40 with uncontrolled diabetes and sleep apnea presents for surgery. Patient has been unsuccessful with dietary methods for weight control. The decision has been made to have a gastric restrictive banding procedure performed.
After general anesthesia, the surgeon inserts five trocar ports and a laparoscope through the abdomen. A gastric band is placed around the upper part of the stomach and this creates a small pouch with a narrow opening that connects to the larger, lower part of the stomach.
Looking in the CPT coding manual Index, see Placement, device, gastric restrictive 43770. This can be verified in the Tabular as:
43770, Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (e.g., gastric band and subcutaneous port components)
AMA guidelines state, “(For individual component placement, report 43770 with modifier 52).”
No modifier is needed in this case.
Adjustable Gastric Restrictive Device
Follow-up care after gastric restriction using the adjustable device typically includes subsequent adjustments throughout the postoperative period. The gastric device can be adjusted by changing the diameter of the device component. This is performed by injecting or aspirating fluid through the subcutaneous port component.
According to the U.S. National Library of Medicine, laparoscopic gastric banding is surgery used to help with weight loss when other dietary and exercise measures have been unsuccessful.
This procedure is not a miracle cure for obesity. Therefore, diet and exercise will still need to be done after the surgery.
The restrictive band makes the patient feel full faster so he or she can only consume small amounts of food. If the patient wants to consume more or less food at some point in the future, the physician can readjust the band.
This gastric banding procedure may be beneficial for patients with:
- A body mass index (BMI) of 40 or more, which means men who are 100 pounds overweight and women who are 80 pounds overweight.
- A BMI of 35 or more in addition to a serious medical problem may improve with weight loss. Sleep apnea, type 2 diabetes, hypertension, and heart disease are some of these serious conditions.
The following video explains what takes place during a laparoscopic adjustable gastric band procedure.
** This post has been updated to reflect the 2021 CPT coding guidelines. **