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Code This!

Scenario Week of October 04, 2011:
View Current Scenario

DIAGNOSIS: Recalcitrant exogenous obesity

OPERATION: Laparoscopic vertical sleeve gastrectomy

INDICATION FOR PROCEDURE: A 38-year-old female with a BMI of 38 presents for laparoscopic vertical sleeve gastrectomy as treatment for exogenous obesity, recalcitrant to diet and exercise.

OPERATIVE PROCEDURE:
The patient is transported to the operative suite, prepped and draped for surgery. Following appropriate anesthesia, a trocar was placed though an incision above the umbilicus, insufflating the abdominal cavity. The laparoscope and additional trocars were placed through small portal incisions in the abdomen. The stomach was visualized and divided through the greater curvature, from the left crus of the diaphragm to a point distal to the pylorus. The short gastric vessels were coagulated and gastric staplers were used. A gastric tube (sleeve) was formed and the remaining 80 percent of the stomach was excised without incident. The instruments were removed and the incisions were closed.

Assign the appropriate ICD-9-CM diagnosis and procedure codes, and the appropriate CPT code


ICD-9-CM Diagnoses and Procedure Codes
278.00 Obesity
V85.38 Body Mass Index 38.0-38.9, adult
43.82 Laparoscopic vertical (sleeve) gastrectomy

Rationale
ICD-9-CM procedure 43.82 is a new procedure code effective October 1, 2011. In ICD-9-CM, sleeve gastrectomy was previously classified to code 43.89 Other partial gastrectomy. New code 43.82 may also be documented as sleeve gastrectomy, vertical gastrectomy, greater curvature gastrectomy, parietal gastrectomy, gastric reduction, longitudinal gastrectomy, or vertical gastroplasty. Review the operative report carefully to determine the appropriate procedure code. If the documentation is incomplete or inconclusive, query the physician for clarification.

CPT Procedure Code
43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy)

Rationale
This code describes a laparoscopic gastric restrictive sleeve or longitudinal gastrectomy. For an open gastric restrictive procedure for morbid obesity, without gastric bypass, other than vertical-banded gastroplasty, report 43843.

 

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