General Surgery Coding Alert

Question: During an office visit, a surgeon in our practice performed a lap band adjustment by saline injection two weeks following surgery to "tighten" the band. Should we bill this as 43771?

Codify Subscriber

Answer: No, you should not report 43771 (Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only) for saline injection or aspiration that the surgeon performs to adjust the lap band.

Code 43771 does not describe the in-office lap-band adjustment that is a normal, ongoing part of managing bariatric surgery to optimize weight loss. Instead, 43771 describes a surgical laparoscopic procedure to revise a component of the gastric band, typically because there is a complication from the prior surgery.

Watch global: The first thing you should know is that if the surgeon adjusts the lap band using saline injection or aspiration during the global period, the service is not separately billable. Rather, it is part of the standard, post-operative treatment.

If you're outside of the global period, how you bill the lap-band adjustment depends on a number of factors. If the surgeon does the adjustment as part of a larger E/M service, you should report only the appropriate E/M code.

If the surgeon simply adjusts the lap band, you might report S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline) or 43999 (Unlisted procedure, stomach), depending on your payer's rules.