General Surgery Coding Alert
Adjustments of Gastric Lap Bands
Question: How should I code for in-office adjustments of gastric lap bands? Can I report 43771? -- Technical and coding advice for You Be the Coder and Reader Questions provided by Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, charge capture manager at University of Washington Physicians.
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 the surgeon would likely only undertake such a procedure to manage a complication.
On the other hand, 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 (... 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 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 (for instance, 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.
General Surgery Coding Alert
- Not All Lymph Excisions Are Equal:
Find Out What Makes the Difference
What you need to get paid for lymph excisions in combination with other breast tissue [...] - Coding Basics:
'New' or 'Established' Might Matter More Than You Think
2 questions allow you to pick the right code -- and right level -- every [...] - You Be the Coder:
What Constitutes Foreign-Body Removal?
Question: Our surgeon saw a patient in the office who had several small metal filings [...] - Medicare Update:
Take Steps to Avoid Growing Consult Confusion
You aren't responsible for the requesting physician's files, CMS says Recent Medicare rules have had [...] - Reader Questions:
Payer Holds the Cards for 91110 Diagnoses
Question: What are the proper CPT and ICD-9 codes to report for using the -gut [...] - Reader Questions:
'Uncertain' ICD-9 Means 'Benign' CPT
Question: The pathologist was unable to determine if a lesion the surgeon removed is malignant [...] - Reader Questions:
Payers Differ on Dermabond Coding Rules
Question: An elderly patient arrived at the office with a 1.4-cm skin tear on his [...] - Reader Questions:
Get Specific With New Decubitus Ulcer Diagnoses
Question: The surgeon treated a patient with decubitus ulcers on his right hip and buttock. [...] - Reader Questions:
Adjustments of Gastric Lap Bands
Question: How should I code for in-office adjustments of gastric lap bands? Can I report [...]
