Anesthesia Coding Alert

Question: I know that 00797 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; for gastric restrictive procedure for morbid obesity) is the correct anesthesia code for 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [less than 100 cm] Roux-en-Y gastroenterostomy), but I'm having trouble with reimbursement for it. What advice do you have on the correct code to use and appropriate reimbursement rates?

South Carolina Subscriber

Answer: Gastric restrictive procedures have been on the rise the past few years; the addition of 00797 to CPT is a big step for physicians and should simplify reimbursement for the procedure. Carriers are frequently slow to adopt new codes, so your problem may be that the carrier has not loaded the 2002 codes into its computer. You may also need to clarify whether the carrier covers the procedure and whether it was authorized. You can try billing with the surgical CPT code (43846) instead of the anesthesia code, and verify that the surgeon obtained authorization for the procedure.