# Any Bariatric Coders Out There?



## hpierce (May 18, 2011)

I work as a coder at a physicians billing office and we do the billing for a Bariatric program. I am new to coding for Bariatrics. Is there anyone that could give me some guidance on diagnosis coding for office visits? Are there any references available out there I could look at? 

I was under the assumption that if they were seeing a bariatric doctor, then the obesity code should always be listed first; why else would you be in a bariatric program? But, what diagnosis do you use when the patient comes back for their follow up visit (post gastric bypass)? Do you use the obesity code as primary or do you use a V code? What about for lap band adjustments? Is it based on the payer?

Any help you could provide would be much appreciated.


Thanks!
Heather P. 
CPC


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## lindacoder (May 18, 2011)

For the initial visit and surgery you use the obesity CPT 278.01, the BMI, and co-morbidities.  After they are out of the global package, for follow up visits use V45.86. If the patient has had a lap band and undergoes a fill or unfill then use V53.51.  Medicare uses these diagnoses as of 10-1-10 - YEA!!  Hope that helps.


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## mjewett (May 18, 2011)

I agree with the diagnosis' given to you, but wanted to add.  If the first fill is performed within the 90 global period to surgery, you can still bill for the fill use modifer 58.  It is the doctor's plan to fill the band, on a later date. No reason why we should have to do the first fill for free.


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## lindacoder (May 19, 2011)

According to General Surgery Coding Alert/2009. Vol.II, No.8 if the patient is still within the global perfiod of the original surgery, adjustments fall within the global period postoperative management and you cannot separately report the service.  In other words, there is no separate new payment for staged adjustments that fall within the surgical global period. 

CPT is clear about this guideline, stating "Typical postoperative follow up care ...after gastric restriction using the adjustable gastric restrictive device includes subsequent restrictive device adjustmentss through the postoperative period for the typical patient. 

Writer goes on to say: "Although I am sure it is possible to get these services paid using a modifier 58 or 78, it is inappropriate nd I would expect the insurer to ask for their money back on review.


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## hpierce (May 19, 2011)

Thanks for all the responses ! I appreciate all the insight. We are having trouble getting some office visits paid because some insurances pay for the 278.01 diagnosis but not the 278.00 or vice versa. The patient either loses or gains weight and the code changes to represent that and then the patient ends up complaining because insurance didn't cover the visit. They call and want us to change the diangosis code back LOL! Anyway, I am trying to learn all the in's and out's of Bariatric coding and it can be confusing at times.


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## bethann2779 (Jul 27, 2011)

*re bariatric*

i have worked denials for some bariatric surgeries and found the dx codes make a difference on the sequence.

1st- obesity code
2nd v code for BMI
3  & 4 co-morbidity dx

hope this helps


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## dawnsofranko (Feb 11, 2012)

Do you know how much Medicare will reimburse for a lap band adjustment?


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## Leanne (Feb 17, 2012)

Medicare will not accept S-code for lap band adjustment.  We bill for it using E/M. 

http://www.medicarenhic.com/providers/articles/gastricband_0807.pdf


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## mjewett (Feb 17, 2012)

You might want to check with your local Medicare carrier for a Bariatric Policy.   local carrier"s (NGS Medicare-J-13)  LCD states we should use the unlisted code 43999 for band adjustments.


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## lindacoder (Feb 17, 2012)

I agree with Melissa - we typically get paid $75 for adjustment of lap band from Medicare


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## hunters (Sep 5, 2013)

*Obesity diagnosis coding - help !!*

Can we list/code the co-morbidities following the obesity code and the BMI code - even if the physician doesn't assess or treat the comorbidities?  The comorbidities (such as HTN or Vit D deficiency) are mentioned only as "pt as history of xxxxx, xxxxx" in the HPI, but thats it.  Then those comorbidities - and sometimes additional ones that weren't even mentioned in the HPI - are listed in the diagnosis list as "comment only".   So my question is whether or not I should/can list all these comorbidities in addition to the obesity diagnosis.  The patients are only coming in for weight management/obesity counseling and sometimes to follow up on metabolic labs.  If I don't list comorbidities, insurances are denying the claims with just the obesity and BMI diagnosis.


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## jettagirlfl (Sep 6, 2013)

http://medicare.fcso.com/coverage_find_lcds_and_ncds/lcd_search.asp


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## jettagirlfl (Sep 6, 2013)

Hey Hunters, I am new to Bariatric as well & I add the co-morbities as well if the patient has had it. Normally if a patient has Diabetes or Hypertension, it really does not go away immediatly you know what I mean? I had trouble latly with our surgeries getting denied for just morbid obesity, have you run into that yet with Medicare?


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## MCook (Sep 7, 2013)

The comorbidities must be on the claim to support the medical need for the surgery.  That is what our local carriers require.  Carriers have specific bariatric policies which you can find online.


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## hunters (Sep 9, 2013)

*Obesity diagnosis coding - help !!*

Yes....in the beginning I was having surgeries come back denied because I wasn't listing the co-morbidities.  I have since found the "Bariatric Surgery for Morbid Obesity" NCD and CMS policy for Bariatric Surgery.  But this only gave me the coding guidance I needed for surgeries.  Fortunately, my surgeons are very good about listing all the co-morbidities in their op note.  My main problem is the office visit for "weight management counseling".  Some insurances will cover only an obesity dx - but many will not.  Even though the pt's may truly have say HTN and sleep apnea as co-morbities, my concern is that the physicians are not addressing, evaluating, or treating them and barely (if at all) documenting them in the office note.  Here is a sample HPI.  

_65 yr old female presents for weight mnmgt f/u.  Weight: 274 today. last weight unchanged. pt has decreased bodyfat mass by 2 pounds and increased muscle mass by 2 pounds. pt states diet is going well. adhering strictly. water intake good. sleep good. pt states she is complaint with vitamins. no new medical issues. pt has been using stair stepper for exercise and plans to invest in a recumbant bike. _

You'll notice not a single co-morbity is mentioned - however, in the assessment/diagnosis list, I'm given the following dx's to bill:  278.01, V85.41, 401.9, 268.9.  No where in the entire note is the HTN and Vit D Def addressed.  SO.....do I bill the co-morbidities with a note that looks like this....or are the physicians required to document something about the co-morbities? I'm thinking they at least have to state the status...what meds are they taking, what were the last lab results, who is treating it, etc.


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## KrJenkins (Nov 12, 2013)

*Bariatric codes?*

I have a similar question with concerns to bariatric Dx's.  Do any of you change your primary Dx from 278.01 to 278.00 once the patients BMI has dropped below 40? and have you had any problems with the claims getting paid?  Do you consider once you are Dx with morbid obesity then it should stay 278.01 as primary when seen at a bariatric office?

thanks for the help!


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## MCook (Nov 17, 2013)

We adjust the 278.0x and the BMI dx code as they lose weight. We have never had a problem with payment.  In fact, I think it shows that the patient is being successful in the weight loss and the surgery worked


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## kimberliterpstra (Dec 2, 2013)

Typically, after the lap gastric bypass and lap sleeve gastrectomy, the patient will have malabsorption (579.3), so we typically use that for follow-up visits, once they are out of their global period.  We also use weight loss (783.21), or weight gain (783.1), depending on their situation.  We also use 278.01, 278.00  or 278.02 as a secondary or tertiary diagnosis.  We always use V45.86 (status-post bariatric surgery) as the tertiary or 4th diagnosis.  We don't have issues with nonpayment.


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