CPT code 43645 Info Needed for Lap DS
This person has been told CPT code 43645 is the Laparoscopic code for the Duodenal Switch, and has been told it is a long-limb gastric bypass (over 150 cm roux limb). The open code 43845 is not covered for this person.
Can anyone help?
Thanks,
Bev
catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp
icd9cm.chrisendres.com/icd9cm/
www.icd9data.com/
Jacqui
Ht 5'9" HW 389 / SW 385 / CW 192/ LW/ 164 / GW 180-190
http://www.facs.org/fellows_info/bulletin/2005/bothe0105.pdf
Gastric restrictive procedures
Two codes were added to the section on laparoscopic procedures on the stomach. Code 43644 is a new code for a laparoscopic gastric bypass and Roux-en-Y gastroenterostomy where the roux limb is 150 cm or less. Code 43645 is a new code for a laparoscopic gastric bypass and small intestine reconstruction. There is one new code and one revised code in the section on open procedures on the stomach. Code 43845 was added to report a biliopancreatic diversion with a duodenal switch. The full descriptor for code 43845 is Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (duodenal switch). Code 43846, the open Roux-en-Y procedure, was revised to change the maximum length of the roux limb from 100 cm to 150 cm.
This CPT is applicable to both open and lap DS.
43645 - Laparoscopy, surgical, gastric restrictive procedure with gastric bypass and small intestine reconstruction to limit absorption.
This code does not describe any specific malabsorptive procedure. However, this is a gastric bypass operation for sure and should not be coded as a DS. If a surgeon codes a DS this way, then he/she has committed insurance fraud.
Vicki 
DS (lap) with Dr. Clifford Deveney. Cholecystectomy (lap) with Dr. Clifford Deveney 19 months post-op.
Has not weighed myself since 1/2010. Letting my clothes gauge my progress instead.
Hi Bev,
I responded to her earlier on a different thread. 43645 is the code that my surgeon's office uses for lap DS. It's also the code that Blue Cross of AL routinely denies for lap DS. It is the code that was approved on appeal by my employer, after they were provided with a wealth of information about the duodenal switch. Now, I can't find anything in my paperwork that specifically states that that code is for lap DS (except for emails from Dr. Smith's office, etc.). However when I googled it the first result I got was a Blue Cross Blue Shield of Rhode Island web site that specifically defines 43645 as the code for laparoscopic biliopancreatic diversion with duodenal switch.
So it appears that these codes are not defined in a uniform way and the definitions vary from one state/company to another.
