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General Surgery Coding Alert

Reader Question ~ Restrictive Procedure Calls for 'Unlisted' Code

Published on Tue Nov 07, 2006

Question: Which is the best code to report laparoscopic gastric restrictive procedure with partial gastrectomy?


New York Subscriber


Answer: CPT does not contain a specific code to report the procedure you describe. In this case, therefore, your best option is to use 43659 (Unlisted laparoscopy procedure, stomach).

For pricing, you should compare the procedure to a listed code that requires a similar level of work and physician resources, such as 43845 (Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy [50 to 100 cm common channel] to limit absorption [biliopancreatic diversion with duodenal switch]).

There's no standard fee for unlisted-procedure codes. Suggest a -comparison- procedure rather than let the payer make an uniformed payment/coverage decision.

You should submit full documentation with every unlisted-procedure claim. To improve your reimbursement chances, you should also include a cover letter with a concise explanation of the procedure, free of unnecessary medical jargon and confusing terminology.
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