Gastric Band Adjustments Update

In November, we reported that Medicare Part B Carrier Palmetto GBA was instructing coders to report an evaluation and management service (99213) for gastric restrictive device band adjustments outside of the global period. Since that time, Palmetto has updated its policy, and now asks that such adjustments be coded using 43999 Unlisted procedure, stomach.

The service is only reimbursable in the office setting, according to Palmetto, and you should write ‘adjustment of lap-band’ in the narrative field of the claim form. Imaging to locate the port is included in 43999.

2017-code-book-bundles-728x90-01

Latest posts by admin aapc (see all)

4 Responses to “Gastric Band Adjustments Update”

  1. Maryann Palmeter says:

    Just some additional information.
    First Coast Service Options, Inc. (FCSO) the Medicare Administrative Contractor for Florida, Puerto Rico and the Virgin Islands issued a local coverage article entitled “Local Coverage Article for Adjustment of Gastric Band after Laparoscopic Gastric Banding Procedure.” The article number is A48436. In FCSO’s article, providers are instructed to report procedure code 43659 (unlisted laparoscopy procedure, stomach). Not sure why providers are instructed to use this code when the injection of the saline solution (to tighten the band) or the aspiration of the solution (to loosen the band) is not performed laparoscopically. However, it may be performed under fluoroscopic guidance. Another reason why it is important to research local Medicare coverage policies. Lastly, for non-Medicare payers who accept HCPCS Level II S-codes, the appropriate procedure to report is S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline).

  2. Michelle says:

    Thank you for taking time to update the information.

  3. Belinda Frausto says:

    I’m not sure why the adjustment is only covered in the office setting. There are times the patient will go to the hospital after hours or away from home and will need the band adjusted. We have had many patients show up in the ER with problems and was admitted by the ER doc. The Bariatric provider was called in after all tests came back negative to find out the only thing the patient needed was a band adjustment. She felt better and was sent home. This isn’t the fault of the bariatric provider seeing the patient off hours and I feel this should be covered at any location as deemed medically necessary.

  4. MARYANN HASTINGS says:

    My RN does thelap band adjsutments and charges the procedure code and 99211.25 E/M routinely. I am concnerned that not every paeint has a seperaely iddentifiable problem to be addressed beside the lap band adjustment. Does anyone else see this as a problem

    thanks

Leave a Reply

Your email address will not be published. Required fields are marked *