General Surgery Coding Alert

Learn 'unlisted' tricks for coding gaps.

Don't lose pay by choosing the wrong code for gastric band and port placement -- or get caught charging too much when your surgeon modifies or removes just one of those elements. Let our experts help you sort through the many codes for gastric band and port placement, revision, adjustment or removal to make sure you always capture the pay you deserve.

Add these tips to our recent article on gastric bypass coding ("Answer 4 Questions to Pick the Right Gastric Bypass Code," General Surgery Coding Alert Vol. 14, No. 8) to make sure you have the whole picture for coding gastric restrictive procedures that your surgeon might do to treat morbid obesity (278.01, Morbid obesity).

"The surgeon may perform the procedures to help the patient lose weight, and perhaps impact coexisting conditions such as diabetes," says Linda Vargas, CPC, CEMC, coding and reimbursement specialist with Cass Regional Medical Center in Harrisonville, Mo.

Tip 1: Distinguish Lap or Open

As with most abdominal procedures, CPT® distinguishes gastric banding codes based on the surgical approach.

"That means you have two groups of codes you'll need to consider when reporting gastric banding procedures -- open and laparoscopic," says Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, audit manager for CHAN Healthcare in Vancouver, Wash.

Get to know the following gastric-banding code choices, grouped by surgical approach:

Laparoscopic:

• 43770 -- Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (e.g., gastric band and subcutaneous port components)
• 43771 -- ... revision of adjustable gastric restrictive device component only
• 43772 -- ... removal of adjustable gastric restrictive device component only
• 43773 -- ... removal and replacement of adjustable gastric restrictive device component only
• 43774 -- ... removal of adjustable gastric restrictive device and subcutaneous port components.

Open:

• 43886 -- Gastric restrictive procedure, open; revision of subcutaneous port component only
• 43887 -- ... removal of subcutaneous port component only
• 43888 -- ... removal and replacement of subcutaneous port component only.

Remember: Never report together a laparoscopic code and the analogous open code, such as 43774 and 43888. You'll find Correct Coding Initiative (CCI) edit pairs for these services. If the surgeon converts from a laparoscopic to open procedure, report only the open procedure and list V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnosis.

Tip 2: Isolate Placement vs. Changes, Port vs. Band

Several parts and processes work together to accomplish morbid-obesity treatment with gastric banding procedures. You need to understand all these components to narrow your code choice.

How it works: During a gastric banding procedure, the surgeon places an adjustable silicone band -- typically just below the gastroesophageal junction. The surgeon also places an access port connected to the band, through which the physician may inject (or aspirate) saline to expand (or contract) the band and effectively manipulate stomach size.

Because the surgery requires the physician to place both the adjustable band and subcutaneous port, and because the patient may require revision/removal/replacement of some parts following the initial surgery, CPT® includes several codes to capture those services.

Once you know if you're looking for an open or lap code, you can make the proper selection based on which of the steps the surgeon performs (placement, revision, removal, replacement), as follows:

Placement:

• Lap placement of band and port -- 43770
• Lap placement of band or port (individual component) -- no specific CPT® code
• Open placement of band and/or port -- no specific CPT® code because this procedure is almost always performed laparoscopically. Similar open procedures are far less

common, and involve stomach "stapling," and no port (such as 43842, Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty).

Revision:

• Lap revision of band -- 43771
• Open revision of port -- 43886

Removal:

• Lap removal of band -- 43772
• Open removal of port -- 43887
• Lap removal of band and port -- 43774

Replacement:

• Lap replacement of band (includes removal of old band) -- 43773
• Lap replacement of band and port (includes removal of old band and port) -- no specific CPT® code.
• Open replacement of port (includes removal of old port) -- 43888.

You'll notice that several procedures don't have a specific CPT® code for either the laparoscopic or open procedure. "In most cases, CPT® provides a code for the most common approach for the procedure," Bucknam says.

But sometimes your surgeon will perform one of the procedures that doesn't have a specific CPT® code, and that's why you need to heed the next tip.

Tip 3: Fill Gaps With Modifiers or Unlisted Codes

Despite a wide range of gastric-band CPT® codes, you'll need a strategy if the op report doesn't match a listed code exactly.

Watch text notes: CPT® provides specific coding instructions for two circumstances as follows:

• When your surgeon places either the band or the port laparoscopically, not both components, a CPT® instructional note directs you to report 43770 with modifier 52 (Reduced services).
• For laparoscopic replacement of both components (band and port, including removal of old band and port), a CPT® text note directs you to use 43659 (Unlisted laparoscopy procedure, stomach).