Summary & Overview
CPT 43847: Gastric Bypass with Small Intestine Reconstruction
CPT code 43847 represents a complex bariatric operation: a gastric restrictive procedure with gastric bypass that includes small intestine reconstruction to treat severe obesity. This code is used for comprehensive surgical interventions that combine stomach reduction with intestinal rerouting to produce durable weight loss and metabolic benefits. Nationally, procedures represented by this code are significant because they address severe obesity and its related comorbidities, affecting utilization, surgical capacity, and payer coverage policies across commercial insurers and Medicare.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for the procedure, typical sites of service, and a summary of what to expect in terms of claims coding and common modifiers. The publication also outlines benchmarks and policy-relevant issues such as inpatient versus outpatient site selection, coding clarity for complex reconstructive steps, and considerations payers commonly apply when reviewing bariatric surgery claims.
This piece is written for a national audience of clinicians, coding professionals, and policy analysts seeking a clear, practical summary of CPT code 43847, its clinical role in bariatric care, and the payer landscape relevant to coverage and claims processing.
Billing Code Overview
CPT code 43847 describes a gastric restrictive procedure with gastric bypass that includes small intestine reconstruction to treat severe obesity. This procedure combines a restrictive component to limit stomach capacity with rerouting and reconstruction of the small intestine to promote weight loss and metabolic effects.
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Service type: Bariatric surgical procedure (open or laparoscopic gastric bypass with intestinal reconstruction)
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Typical site of service: Inpatient hospital or ambulatory surgical center, depending on patient complexity and perioperative needs.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, or related procedure codes.
Clinical & Coding Specifications
Clinical Context
A 42-year-old patient with a body mass index (BMI) of 44 kg/m2, type 2 diabetes mellitus inadequately controlled on medical therapy, and obstructive sleep apnea is evaluated for surgical management of severe obesity. After multidisciplinary evaluation including nutritional, behavioral, and anesthesiology assessments, the patient is scheduled for a Roux-en-Y gastric bypass with gastric restrictive component and small bowel reconstruction to create a gastric pouch and alimentary limb. The typical clinical workflow includes preoperative clearance and optimization, informed consent, general anesthesia with endotracheal intubation, laparoscopic or open creation of a small gastric pouch, construction of a gastrojejunostomy, and small intestine reconstruction (creation of alimentary and biliopancreatic limbs). Postoperative care includes monitoring in the PACU, pain control, early mobilization, deep vein thrombosis prophylaxis, gradual diet advancement, and outpatient follow-up with nutrition and bariatric surgery clinic for long-term weight-loss and metabolic monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Default when no modifier applies |
22 | Increased procedural services |