Coding for Laparoscopic Gastric Plication/ Laparoscopic Greater Curve Plication:
Laparoscopic Greater Curve Plication is a bariatric procedure developed in Iran and South America. The intent of the operation is to produce early and persistent satiety with small low calorie meals to effect significant weight loss. The conceptual basis for the operation is gastric volume reduction by inverting the stomach into itself and suturing it in this position. Published series from outside the United States report mobilization of the greater curve of the stomach, including the short gastric arteries, and then inversion/imbrication of the greater curve from the GE Junction to within several centimeters of the pylorus. Generally two or three layers of sutures are used to perform the procedure. Endoscopic guidance is generally used during the procedure to help guide the degree of restriction. One US trial compared anterior gastric plication alone without mobilization of the greater curve to full greater curve plication. While anterior plication was presumed to be safer, weight loss was superior and more durable in the greater curve group.
Coding for Gastric Plication: The standard accepted bariatric procedures have ICD-9-CM and CPT procedure codes intended for use with these operations and accepted by payers. Gastric Plication has not been through this lengthy process. As billing is much easier with a standard accepted code, surgeons and coders are tempted to look at existing codes and see if they apply.
ICD-9-CM Vol.3 procedures codes:
44.68 Laparoscopic gastroplasty
Silastic vertical banding
Vertical banded gastroplasty (VBG)
Code also any synchronous laparoscopic gastroenterostomy (44.38)
Inversion of gastric diverticulum
Repair of stomach NOS
As can be seen the title for ICD-9-CM vol. 3 44.68 appears to apply. However under the detail, there is clarification on its use and procedures to be used with. This code is intended for use in non-adjustable gastric banding (adjustable banding has its own unique code), and VBG and its variants. These procedures are clearly different conceptually and involve very different surgical techniques. Even 44.69 doesn’t really apply even as an “other” code once the details are examined
These codes are procedure specific and generally include a description of the procedure in the code itself. Gastric Plication has not been through the CPT process for code development and valuation. Should the procedure become widely performed and establish a base of literature supporting its use, this process can be initiated. If Gastric Plication was already part of another procedure, use of the applicable code with a reduced work modifier (as is recommended for hiatal hernia repair in conjunction with some bariatric procedures) might be appropriate. However such a procedure does not currently exist. Therefore the unlisted code 43659 is the only appropriate CPT code for this procedure.
As is standard for billing 43659 with insurers the practice would need to include a cover letter suggesting a comparable procedure for charge purposes and the operative note. At this point, many insurers specifically exclude gastric plication as investigational, so this is unlikely to result in insurance payment.
For any bariatric surgery insurance questions please email Insurance@asmbs.org
Matthew L. Brengman, MD, FASMBS
Chair, Insurance Committee