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A laparoscopic gastric restrictive procedure involves the surgical placement of an adjustable gastric restrictive device, which typically includes a gastric band and subcutaneous port components. This minimally invasive technique is designed to assist in weight management by restricting the amount of food that can be consumed. The procedure begins with the introduction of a Veress needle to insufflate the abdomen, creating a working space for the surgeon. Following this, multiple trocars are strategically placed to facilitate the insertion of surgical instruments. The use of a nasogastric tube is essential for identifying the stomach's location during the procedure. The surgeon dissects the lesser curvature of the stomach and manipulates the gastrohepatic ligament to create a pathway for the gastric band. The band is then positioned around the stomach, and its placement is meticulously adjusted and secured. The procedure concludes with the installation of a subcutaneous access port, which allows for future adjustments to the gastric band. This technique is particularly beneficial for patients seeking a surgical option for weight loss, as it provides a reversible and adjustable method for managing obesity.
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The laparoscopic gastric restrictive procedure with the placement of an adjustable gastric restrictive device is indicated for patients who meet specific criteria related to obesity and weight management. The following conditions may warrant this procedure:
The laparoscopic gastric restrictive procedure involves several critical steps to ensure the successful placement of the adjustable gastric band. The procedure begins with the introduction of a Veress needle into the abdominal cavity, which allows for the insufflation of carbon dioxide gas to create a working space. Following this, five trocars are inserted: one below the xiphoid for the camera and optical system, one in the midline for a liver retractor, one in the right upper quadrant for grasping forceps and the gastric band tool, one in the left upper quadrant for a cautery hook, needle holder, and additional grasping forceps, and one on the left anterior axillary line for further manipulation. A nasogastric tube is then placed and inflated to help identify the stomach's location accurately.
Next, the surgeon dissects the lesser curvature of the stomach, using one set of grasping forceps to hold the gastrohepatic ligament and another to place tension on the gastric wall. A small opening is created between the gastrohepatic ligament and the lesser curvature to facilitate the placement of the gastric band. The phrenogastric ligament is also placed under tension, and a small window is created using a coagulation hook. An endo grasp is introduced and passed through the retrogastric tunnel until it is visible in the phrenogastric window, where it is advanced to grasp the diaphragm above the spleen.
Once the gastric band is introduced and secured using the endo grasp, it is looped around the stomach and tightened to the desired level. The position of the band is carefully checked and adjusted as necessary before being locked in place. Saline solution is then injected into the inflatable balloon of the band to calibrate the tension. The tube is clamped, and any excess length is cut and removed. The band is secured in position with sutures, and the access port is placed in the subcutaneous tissue of the abdomen, connecting it to the injection reservoir. Finally, the reservoir is fixed to the abdominal fascia in the left hypochondrium, and any necessary gastric band adjustments are scheduled for postoperative care in the radiology department.
After the laparoscopic gastric restrictive procedure, patients are typically monitored for any immediate complications and provided with postoperative care instructions. Recovery may involve a brief hospital stay, during which the surgical site is assessed for signs of infection or other issues. Patients are advised to follow a specific diet plan that gradually progresses from liquids to solid foods as they heal. Follow-up appointments are essential for monitoring weight loss progress and making any necessary adjustments to the gastric band. Adjustments are performed in the radiology department, where saline can be added or removed from the band to optimize its effectiveness. Patients are encouraged to engage in lifestyle changes, including dietary modifications and physical activity, to support their weight loss journey.
| Short Descr | LAP PLACE GASTR ADJ DEVICE | Medium Descr | LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE | Long Descr | Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Hospital Part B services paid through a comprehensive APC | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 244 - Gastric bypass and volume reduction |
This is a primary code that can be used with these additional add-on codes.
| 49327 | Addon Code MPFS Status: Active Code APC N ASC N1 Laparoscopy, surgical; with placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), intra-abdominal, intrapelvic, and/or retroperitoneum, including imaging guidance, if performed, single or multiple (List separately in addition to code for primary procedure) |
| 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 80 | Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s). | AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | GA | Waiver of liability statement issued as required by payer policy, individual case | GZ | Item or service expected to be denied as not reasonable and necessary |
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| 2008-01-01 | Changed | Code description changed. |
| 2006-01-01 | Added | First appearance in code book in 2006. |
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