General Surgery Coding Alert

Question: After the follow-up period and initial adjustments for a lap-band procedure, the patient returned in six months, and the surgeon refilled the gastric lap band reservoir through the port. Two days later, the patient returned complaining of nausea and vomiting. Here's the note for the procedure the surgeon reported on that day: "Under intermittent fluoroscopic guidance, a 22 gauge short needle was advanced into the port reservoir. 5 cc of clear saline fluid was aspirated out of the port. The needle was »»» removed and a sterile bandage was applied." How should we code these procedures?

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Answer: For the visit 6 months post- procedure, you would report S2083 (Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline) for payers who accept S codes. Otherwise, you may have to include the service in the appropriate E/M code, depending on payer preference.

When the patient returns two days later, it's a different story. Because the surgeon documented using fluoroscopic guidance to direct the needle to aspirate the lap-band reservoir, you should also report 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]).

Background: The procedure for lap-band adjustment involves passing a needle into the port of a band placed around the patient's stomach as part of bariatric surgery. Your surgeon may use the needle to add or remove fluid to change the width of the stoma, or opening into the stomach.

The adjustment is typically performed through a subcutaneous port. If it's palpable, the physician may not require guidance. But sometimes the surgeon may need guidance to find the port, as you've documented in this case.