# Bariatric Surgery Coding Questions



## michaelle (May 16, 2012)

I need some input/assistance with bariatric surgery coding. My questions are:

1. Is there a better way to code for a Laparoscopic Duodenal Switch other than with a 43659? I know that 43845 is for open only. 

2. How are you coding for the laparoscopic removal of a band, including all components with a conversion to a Roux-en-Y during the same operation? Please include any modifiers you may use to either indicate increased procedural services (22) for the adhesions, etc. or if you use a 51 to indicate multiple procedures and any explanations for your choice of modifier.

Thank you!


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## Torilinne (May 17, 2012)

43659 is the most accurate code, that I know of, for laparoscopic duodenal switch.  It would be inappropriate to code each element (sleeve gastrectomy, cholecystectomy, and appendectomy) individually.  

You may code 43644 for the lap Roux-en-Y and use 43774 with a 51 modifier for the removal of gastric band and components.  The 51 modifier will indicate the multiple procedure and appropriately adjust the reimbursement for this second portion of the surgery.  A 22 modifier would not be used for lysis of adhesions as these are usually a component of the Roux-en-Y, unless the documentation supports substantial extra time or difficulty relating to the adhesion removal.  

Hope this helps!
Torilinne
SCC, CPC, CGIC


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## cjrottum (Mar 21, 2014)

*another scenario*

So I have a similar scenario but slightly different.  We have a patient who had a gastric band slip and cause dysphagia so the doctor performed a laparoscopic gastric band removal with all components (43774) and then he did a laparoscopic gastrectomy as a replacement procedure (43775).  In addition, the patient is no longer morbidly obese and he has MCR.  His BMI is now 25.  Medicare paid the 43774 with the complication code but they are not paying the 43775 and from the LCD I see that they only cover 278.01 with the BMI code and the co-morbidities coded.  Is there a way to get the 43775 covered or should I use an unlisted code like the 43659 with the description of the conversion to a gatrectomy and then the complication coding.
Thanks,
Corrina Rottum, RHIT, CGIC


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## lindacoder (Mar 24, 2014)

We too have had a patient have their slipped band removed and conversion to another bariatric procedure who's BMI did not meet Medicare's guidelines therefore they will not pay.  My doc dictated a letter stating necessity but on appeal it did not matter. Unfortunately they have to wait until they regain their weight and then Medicare will pay. Some commercial insurances also only will pay for one bariatric surgery a lifetime so you have to watch for that also.


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## cjrottum (Apr 2, 2014)

In going through a million threads on code correct coach, I am finding that billing this whole scenario with 43659 and then a 22 modifier and combing the amounts for the two procedures then using the complication dx code with the status post bariatric code is what other clinics are doing.  I asked a question on this to an outisde auditing agency in our state as well and they agreed that this scenario would qualify for coding this way.  Obviously a surgical report would need to be submitted.  I will keep and eye on it and see if this works.  In our particular case, the doctor states that significant additional time was required so hopefully the 22 will work.


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