Wiki Bundled Bariatric Procedures

[motherzone]

Our Bariatric surgeons are in the habit of billing for an EGD to check their anastomosis during rouen-y surgeries. They are also separatly billing for wedge liver biopsies with the unlisted liver code.
I know that these should be included, but have been searching for good documentation specific to bariatrics.
I have the endoscopy guidlines, but am hoping to find something specific as these guys are pretty tough, and will be quite resistant unless I can show them documentation.
Thanks for any suggestions.

 

[Amy Pritchett]

My first question is, why are the billing the liver wedge biopsy under an unlisted code when the code for liver wedge biopsy is (47100)? Also, when the EGD is diagnostic to check for complications from a procedure, this is "inherent" to the primary procedure of the Roux-En-Y procedure and therefore is not billable. You can reference (www.cms.gov/NCCI) for further information regarding these codes being billed together.

I can understand your situation completely with your providers. I have found in my personal profession that if you take the "correct" codes and guidelines to the physicians and explain to them that the guidelines state and what can happen if they are non-compliant that they are normally inclined to listen. However, they are the physician and there is a fine line there. Just make sure that you are not accusatory of the physician (they tend to shut down) when this happens.

I hope this has helped you in some way

 

[motherzone]

Thanks for the reply.
They are performing the liver biopsy laparoscopically at the same session as the bariatric surgery. The 47100 description is that an incision is made into the abdominal wall. They are already at the area and have generally retracted the liver to perform their stomach and intestinal staples which to me makes it even more included.

I will further check your link.Thanks