Gastroenterology Coding Alert

Question: How should I code for in-office adjustments of gastric lap bands? Can I report 43771?

Arizona Subscriber

Answer: To adjust a gastric band, the physician can inject or aspirate saline into an access port, which connects to the band, and effectively manipulate stomach size (and thus control appetite suppression, satiety and weight loss).
 
CPT added 43771 (Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only) in 2004, but this code does not describe gastric band adjustments (by saline injection or aspiration). Rather, this is a surgical procedure that involves laparoscopic manipulation of a gastric band placed during a previous procedure. Such revisions are not routine, and a gastroenterologist would only undertake such a procedure to manage a complication.
 
But the physician performs -adjustments- routinely (generally in the office) several times a year to optimize weight loss. You should include such adjustments to the gastric band by saline injection/aspiration (which is a nonsurgical procedure) as a standard postoperative component of 43770 and 43773, according to CPT rules and the AMA's CPT Changes 2006: An Insider's View.

 In other words: You cannot be paid for gastric band adjustments during the global period of the major procedure.
 
After the global period: You can report gastric band adjustments using standard E/M visit codes (e.g., 99211-99215). the physician must still document the components of history, exam and medical decision-making to justify the E/M service level. Merely noting -adjusted lap band- won't go very far in supporting a billed service.