Summary & Overview
CPT 43843: Restrictive or Partial Stomach Resection for Morbid Obesity
CPT code 43843 denotes a bariatric surgical procedure in which a portion of the stomach is walled off with staples or sutures, or a portion is removed and the incision closed, to treat morbid obesity. It is distinct from gastric bypass procedures and is used to lower the likelihood of complications commonly associated with bypass, such as intestinal obstruction and micronutrient deficiencies. Nationally, this code captures a specific set of restrictive or resective bariatric interventions that influence surgical utilization, perioperative planning, and long-term nutritional follow-up.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical intent and care setting for the procedure, typical billing considerations, commonly reported modifiers, and context for utilization benchmarks and coverage policy trends. The report highlights clinical rationale for choosing a non-bypass approach, implications for post-operative monitoring, and the operational settings where the service is delivered. Data not available in the input is clearly identified elsewhere in the publication.
Billing Code Overview
CPT code 43843 describes a surgical procedure in which the surgeon walls off a portion of the stomach with staples or sutures, or removes a portion of the stomach and closes the incision, to treat morbid obesity. The procedure is performed to avoid a gastric bypass and reduce risks such as intestinal obstruction, anemia, osteoporosis, protein deficiency, and vitamin deficiency that are more typical of bypass procedures.
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Service type: Bariatric surgical procedure for treatment of morbid obesity
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Typical site of service: Inpatient or outpatient hospital surgical setting (operating room), depending on clinical presentation and complexity
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with morbid obesity (BMI 44 kg/m2) and obesity-related comorbidities—controlled type 2 diabetes mellitus and hypertension—presents after multidisciplinary evaluation recommending a restrictive bariatric procedure. The surgeon elects to perform a gastric restrictive operation in which a portion of the stomach is walled off with staples or sutures (sleeve or restrictive stapling procedure) or a partial gastrectomy with closure of the incision to reduce gastric volume while avoiding intestinal bypass. The typical clinical workflow includes preoperative evaluation (nutrition, psychology, medical clearance), informed consent emphasizing expected benefits and complications, preoperative labs and imaging, anesthesia evaluation, the operative procedure in an accredited ambulatory surgery center or hospital operating room, postoperative monitoring in PACU, inpatient observation for 24–48 hours when indicated, and scheduled follow-up visits with dietitian and surgeon for progressive diet advancement, weight-loss monitoring, and surveillance for nutritional deficiencies or complications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unspecified modifier (as submitted) | Rarely used; typically not appended unless a payer requires a placeholder. |
11 |