Radiology Coding Alert

Question: In a patient who complained of nausea and vomiting after a recent filling of gastric lap band reservoir, our physician did a fluoroscopic guided aspiration to adjust the band.

In the clinical note, the procedure is described as follows:

“Under intermittent fluoroscopic guidance, a 22 gauge short needle was advanced into the port reservoir. 5 cc of clear saline fluid was aspirated out of the port. The needle was removed and a sterile bandage was applied.”

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Answer: You report the aspiration for LAP-BAND adjustment with code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]). The code 77002 applies to an outpatient setting. Since your physician has clearly documented the use of fluoroscopic guidance for this procedure, 77002 is the right choice.

What is LAP-BAND adjustment? The procedure for LAP-BAND adjustment involves passing a needle into the port of a band placed around the patient’s stomach as part of bariatric surgery. Your radiologist may use the needle to add or remove fluid to change the width of the stoma.

The adjustment is typically performed through a subcutaneous port. If it’s palpable, the physician may not require guidance. But for patients who need to lose a lot of weight or for patients who have already lost weight and have a lot of extra skin, your radiologist may need guidance to find the port.

Watch for the global period: Keep in mind adjustments performed during the bariatric surgery’s global period are included in the surgical fee, so you should not report them separately. You may report adjustments performed after the global postoperative period ends.

For those (non-Medicare) payers who accept S codes, you may report S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline). Otherwise, you may have to include the service in the appropriate E/M code, depending on payer preference.