General Surgery Coding Alert

Follow payer guidelines for code choice.

Can you collect pay when your surgeon uses the subcutaneous port to adjust a gastric band?

That might be the question on your mind now that you know how to code your surgeon's work for placing/removing gastric bands (see "43770 and Beyond: 3 Tips Promise Proper 'Banding' Code Choice" in this issue).

Watch Surgical Global Period

The answer to the opening question is, "no," you can't collect lap-band adjustment pay -- at least not if you're still in the surgical global period. That's 90 days for 43770 (Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device [e.g., gastric band and subcutaneous port components]).

"CPT® clearly states that band adjustment, to include injecting or aspirating fluid, is part of the typical post-operative follow-up care for adjustable gastric restrictive devices," says Linda Vargas, CPC, CEMC, coding and reimbursement specialist with Cass Regional Medical Center in Harrisonville, Mo.

Distinguish 'Adjustment,' 'Revision'

Don't be fooled by the fact that CPT® provides the following two procedure codes for lap-band revision:

• 43771 -- Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only
• 43886 -- Gastric restrictive procedure, open; revision of subcutaneous port component only.

"You shouldn't use revision codes to report lap-band adjustment," Vargas says. These codes represent surgical procedures done in the operating room, such as adjusting the band for band slippage, she says.

On the other hand: Adjustment is the required process of loosening or tightening the lap band to achieve proper restriction for weight loss. Specifically, CPT® states that, "Adjustment consists of changing the gastric restrictive device component diameter by injection or aspiration of fluid through the subcutaneous port component."

Follow Payer Guidance Beyond Global Period

If your surgeon performs a lap-band adjustment after the 90-day global period, you should be able to charge for the service, depending on the payer.

Although there is currently no specific CPT® code for gastric-band adjustment, you may be able to report the procedure using S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline) or 43999 (Unlisted procedure, stomach), depending on payer instruction.