General Surgery Coding Alert

Question: How should I code for adjustments my surgeon makes to a laparoscopically placed gastric band? Generally, the surgeon will see the patient in the office and make these adjustments by injecting (or sometimes aspirating) saline solution via a port. Is 43771 appropriate for this service?


California Subscriber

Answer: Gastric band adjustments (by saline injection or aspiration) are not the same as revisions as described by 43771 (Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only).

The surgeon 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 (Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band [gastric band and subcutaneous port components]) and 43773 (- removal and replacement of adjustable gastric band component only), according to CPT rules and the AMA's CPT 2006 Changes: An Insider's View.

In other words: You cannot report a separate service for band adjustments during the primary procedures- global period.

For adjustments made outside the global period, you should consider the work of the service as a factor when deciding on an appropriate-level E/M code.

On the other hand, gastric band revision (43771) involves laparoscopic surgery to manipulate a gastric band placed during a previous procedure. Such separately billable revisions are not routine, and a surgeon would only undertake the procedure to manage a complication.