General Surgery Coding Alert

Question: We had a patient who, following a lap band procedure, had a dilated pouch. To treat the dilation, the surgeon removed saline through the subcutaneous port to minimize the band restriction, and put the patient on a liquid diet for two weeks. A month later, the patient returned, again with a dilated pouch. This time the surgeon laparoscopically “unbuckled” the band. Should we use the same procedure code to bill for the lap band draining and unbuckling that the surgeon provided on the different dates?

California Subscriber

Answer: No, you should not use the same code to report both the lap band adjustment (by draining the saline) and the lap band unbuckling.

Loosening or tightening a gastric lap band involves adding or draining fluid via a needle in a port. If the procedure takes place during the 90 day global period for surgically placing the lap band, you should not separately bill for the procedure.

However, if the lap band adjustment by adding or removing saline through the port occurs outside of the global period, you may be able to report the service as S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline) or 43999 (Unlisted procedure, stomach), depending on your payer.

Unbuckling is different: Some lap bands come equipped with a buckle, which the surgeon can access laparoscopically. By unbuckling the band, the surgeon is able to effectively undo the banding procedure without actually surgically removing the band. Then, at some future time, the surgeon can laparoscopically rebuckle the lap band.

The correct code for unbucking or rebuckling a lap band is 43771 (Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device, component only).