Wiki Stumbled across procedure- Please Help!

[hpatzke]

I have a provider who has on several occasions found he has to perform another procedure while also performing the procedure he went in to perform.

Example:

My procedure has performed CPT 43770- Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components). While performing this procedure he stumbled across a hiatal hernia that needed to be repaired and performed the repair of the hiatal hernia (laparascopically).

Would it be appropriate to bill 43281 or 43282 (depending on if mesh is used) with 43770? These codes do not bundle but the stumbled across procedure has higher RVU's. I know usually you would bill in RVU order, but would that apply in this case?

Any help on this is greatly appreciated.

 

[LMCODER]

You cannot bill for a hernia repair with a lap band. It's usually just a couple of stiches to repair the hernia.

Laura

 

[MCook]

Laura, Can you state your reference for this? I need this in writing as I have not seen it documented anywhere that this can not be done.

Thanks for your help!
Michelle

 

[kbarbag]

Michelle,
Check your CCI edits on the CMS web sit. that will tell you if it is bundled or not. The Ingenix Encoder pro shows they can be billed together.
Good luck
Kathy

 

[MCook]

Thanks Kathy. That is what we have been going by also. If we were doing this in error and it was documented somewhere, I wanted to make sure I shared that with the doctors. I just had never seen that it was bundled or any directive that it could not be billed. Thanks for your input.

Michelle