Radiology Coding Alert

Question: Our radiologists perform percutaneous LAP-BAND adjustments. We report S2083 for the service and 77002 for the fluoroscopy. Is this the correct fluoroscopy code?

Connecticut Subscriber

Answer: Code 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) is appropriate for fluoro used for gastric band adjustment in the outpatient setting, according to the American Hospital Association's Coding Clinic for HCPCS, Vol. 9, No. 3, 2009. Of course, the code is only appropriate when the physician uses and documents the fluoroscopic guidance.

The procedure: LAP-BAND adjustment involves passing a needle into the port of a band placed around the patient's stomach as part of bariatric surgery. The radiologist uses the needle to add or remove fluid to change the width of the stoma (the outlet the band creates between the two parts of the stomach), according to CPT Assistant (April 2006).

The physician typically performs the adjustment 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, the radiologist may need guidance to find the port.

Keep in mind that 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.