43775

Laparoscopic Sleeve Gastrectomy

CPT 43775 describes a laparoscopic surgical gastric restrictive procedure known as a longitudinal gastrectomy, more commonly referred to as a sleeve gastrectomy. During this procedure, a surgeon uses laparoscopic techniques to remove approximately 75% to 80% of the stomach along the greater curvature. This anatomical modification results in the stomach resembling a narrow tube or 'sleeve,' significantly reducing its volume and capacity for food intake. Beyond the mechanical restriction, the procedure is physiologically potent because it involves the resection of the gastric fundus, which is the primary site of production for ghrelin, a hormone that stimulates hunger. By reducing ghrelin levels and increasing gastric emptying speed into the small intestine, the procedure modulates metabolic pathways and satiety signals. The surgery is typically performed through five or six small abdominal incisions using specialized stapling devices. It has become the most common bariatric procedure performed globally due to its relative technical simplicity compared to a gastric bypass, the absence of intestinal re-routing (which minimizes malabsorption risks), and its high efficacy in inducing weight loss and resolving metabolic comorbidities such as Type 2 diabetes and hypertension. The surgeon must carefully calibrate the size of the remaining gastric sleeve using an orogastric bougie to prevent strictures or inadequate weight loss.

Clinical Indications

  • Morbid obesity with a Body Mass Index (BMI) of 40 or greater
  • Obesity with a BMI of 35-39.9 and at least one significant obesity-related comorbidity such as Type 2 diabetes, obstructive sleep apnea, or hypertension
  • Failure of non-surgical weight loss programs (diet, exercise, behavioral therapy)
  • High-risk surgical candidates for whom more complex procedures like Roux-en-Y gastric bypass are contraindicated
  • Initial stage of a planned two-stage bariatric procedure for extremely high-BMI patients (BMI > 60)

Procedure Steps

  1. Patient is placed in a supine or split-leg position under general anesthesia.
  2. Pneumoperitoneum is established and laparoscopic ports are placed in the upper abdomen.
  3. The liver is retracted to expose the hiatus and the upper portion of the stomach.
  4. The greater curvature of the stomach is mobilized by dividing the gastrocolic and gastrosplenic ligaments using an energy device.
  5. The mobilization starts approximately 4 to 6 cm proximal to the pylorus and continues up to the Angle of His, ensuring the fundus is fully freed from the diaphragm.
  6. An orogastric bougie (typically 32 to 40 French) is passed into the stomach and positioned along the lesser curvature to act as a sizing template.
  7. A laparoscopic linear stapler is used to divide the stomach longitudinally, starting from the antrum and proceeding toward the fundus, following the guide of the bougie.
  8. The resected portion of the stomach (the greater curvature and fundus) is removed from the abdomen through an enlarged port site.
  9. The staple line is inspected for hemostasis, and a leak test (using methylene blue or air) may be performed to ensure integrity.
  10. Ports are removed and incisions are closed.

Coding Guidelines

  • Code 43775 is a specific code for the laparoscopic approach; if the procedure is performed via an open incision, use 43843.
  • Do not report 43775 in conjunction with other gastric restrictive procedures such as 43770 (laparoscopic banding) or 43846 (gastric bypass).
  • Laparoscopic sleeve gastrectomy is considered a permanent procedure, unlike gastric banding.
  • If a hiatal hernia repair (43281) is performed at the same time, check individual payer policies as some allow separate reporting with modifier 51 if the hernia is clinically significant and not just a small incidental finding.
  • Assistant surgeon services (modifier 80 or 82) or a Co-surgeon (modifier 62) may be covered depending on the complexity and medical necessity, though many payers have specific restrictions for bariatric surgery.
  • The removal of the specimen is included in the primary code and should not be billed separately.

Associated ICD-10 Codes