General Surgery Coding Alert

Question: How should I code for in-office adjustments of gastric lap bands?

Arkansas Subscriber

Answer: There is no specific code for an adjustment of the gastric band. How, and if, you report gastric lap band adjustments depends on whether the adjustment occurs within the global period of the major procedure.

If the patient is still within 90 days of the original surgery, adjustments fall within the global period for post-operative management and you cannot separately report the service.

In other words: There is no separate new payment for staged adjustments that fall within the surgical global period.

Alternately: If your surgeon performs a medically necessary adjustment after the 90-day global period, you may report the service using 43999 (Unlisted procedure, stomach).

Note: If your physician uses fluoroscopic guidance, you can also report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71024 [e.g., cardiac fluoroscopy]).

To adjust a gastric band, the physician can inject or aspirate saline into an access port, which connects to the band, and effectively manipulate stomach size (and thus control appetite suppression, satiety, and weight loss).

CPT added 43771 (Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only) in 2004, but this code does not describe gastric band adjustments (by saline injection or aspiration). Rather, this is a surgical procedure that involves laparoscopic manipulation of a gastric band placed during a previous procedure.

These types of revisions are not routine, and the surgeon would likely only undertake such a procedure to manage a complication.

On the other hand, the physician performs "adjustments" routinely (generally in the office) several times a year to optimize weight loss. You should include such adjustments to the gastric band by saline injection/aspiration (which is a nonsurgical procedure) as a standard postoperative component of 43770 (... placement of adjustable gastric restrictive device [gastric band and subcutaneous port components]) and 43773 (... removal and replacement of adjustable gastric restrictive component only).Bonus: You can report an E/M service if it is separately identifiable from the actual adjustment. For example, if the patient presents with a new problem during the same office visit during which the surgeon adjusts the gastric band, report the appropriate established patient visit (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient - ) with modifier 25 appended (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).