Summary & Overview
CPT 43842: Gastric Resection of Ghrelin-Producing Portion for Morbid Obesity
CPT code 43842 denotes a bariatric surgical procedure that removes the part of the stomach that produces ghrelin, the hormone linked to hunger, and closes the stomach with staples or sutures. The procedure is intended as an alternative to gastric bypass to reduce risks such as intestinal obstruction, anemia, osteoporosis, protein deficiency, and vitamin deficiency commonly associated with bypass operations. Nationally, this code is relevant for surgical programs addressing morbid obesity and for payers evaluating coverage and utilization of restrictive stomach procedures.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an explanation of the clinical rationale for this resection procedure, the likely service setting and perioperative considerations, and the typical policy topics payers consider when evaluating coverage (medical necessity criteria, comparative complications versus bypass, and expected postoperative monitoring needs). The publication summarizes available benchmarks and common billing constructs tied to this service and highlights policy and coding areas where payers may apply specific authorization and documentation requirements.
Data not available in the input for associated taxonomies, specific ICD-10 diagnosis codes, related CPT codes, and payer-specific reimbursement rates.
Billing Code Overview
CPT code 43842 describes a surgical procedure in which the provider removes the portion of the stomach that produces the hormone ghrelin and then closes the stomach with staples or sutures. This operation is performed to treat morbid obesity by reducing the physiological drive for hunger through resection of ghrelin-producing tissue.
Service type: Bariatric surgery — gastric resection for hunger suppression
Typical site of service: Inpatient hospital or hospital outpatient surgical center, depending on patient acuity and facility capabilities.
Clinical & Coding Specifications
Clinical Context
A 42-year-old woman with a body mass index (BMI) of 44 kg/m2, long-standing obesity-related comorbidities including hypertension and obstructive sleep apnea, and failed conservative weight-loss measures presents for evaluation for bariatric surgery. After multidisciplinary assessment including nutrition, psychology, and medical clearance, the surgeon elects to perform a sleeve gastrectomy (vertical sleeve gastrectomy) to remove the ghrelin-producing portion of the stomach and close the gastric remnant with staples. The procedure is performed electively in an accredited ambulatory surgery center or hospital operating room under general endotracheal anesthesia. Perioperative workflow includes preoperative consent, pre-anesthesia assessment, operative stapling of the greater curvature with leak testing, intraoperative prophylactic antibiotics, postoperative recovery in the PACU, inpatient observation or same-day discharge per protocol, and scheduled follow-up for nutrition and vitamin monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service not defined by CPT/HCPCS | Not typically used; reserved for nonstandard reporting when required by payer guidance |
11 | Primary procedure |