General Surgery Coding Alert

Question: When a bariatric surgery patient comes to the office for a lap band fill, how can we bill for the  service if an RN performs this follow-up procedure?

Arkansas Subscriber

Answer: Correct coding depends on the payer, and your code selection also may vary by region for national payers, such as Medicare. There is a HCPCS Level 2 code, S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline), that some payers may require, although typically Medicare won't accept it. If your payer doesn't want you to use S2083, you'll have to report the service with unlisted code 43999 (Unlisted procedure, stomach).

Watch global period: You should not bill for a lap band fill during the global period of the original lap band placement, no matter who performs the service. After the end of the global period, you may separately bill for adjusting the lap band.

Meet POS and incident-to rules: If you meet all the above requirements, that doesn't guarantee that you can bill for the service when a nurse provides it. The place of service (POS) must be 11 (Physician office) and you must meet the incident-to requirements before you can bill the nurse's service for the lap band fill. Incident-to rules require that the physician meet with the patient on the first visit to establish a care plan, and the physician be on the premises to supervise the nurse.