General Surgery Coding Alert

Question: My surgeon performed a laparoscopic gastric sleeve procedure. Three days later, he performed an exploratory laparotomy with closure of gastric perforation due to a staple line leak. How should I code the procedures for the first and second day?

Minnesota Subscriber

Answer: Report the laparoscopic gastric sleeve procedure as 43775 (Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy [i.e., sleeve gastrectomy]).

The appropriate code for the perforation closure is 43840 (Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury).

Because the surgeon performs the gastric wound suture during the 90-day global period for the gastric sleeve, you'll need to use a modifier. The second procedure is related to the first, but it is not planned. That means you should use modifier 78 (Unplanned return to the operating /procedure room by the same physician following initial procedure for a related procedure during the postoperative period).

Remember: Medicare will only pay for treating a complication during the surgical global period if treatment requires a return to the operating room.