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Wiki Bariatric question???

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herrera4

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If someone is having complications with a gastric band and decide to have a bypass...would you ever bill 43774 and 43644 together?? im thinking this would be bundled..maybe a -22 if note qualifies. a co-worker thinks just because BCBS approves BOTH procedures BOTH s/b billed and paid

TIA:)
 
It could come down to the carrier. THere is not a CCI edit on it which technically means you can bill both together BUT chapter 4 of the CCI edits states that if you have to remove hardware as an integral part of the primary procedure it would be considered inclusive. (this could very well be applied by the carrier to the fact that removing the components of the band has to be done in order to complete the bypass). Here is some info:

Per CCI Chapter Four it states that if you have to remove hardware to place new it is usually considered inclusive.

CCI Chapter Four:
"7. There are CPT codes (20670 and 20680) for removal of internal fixation devices (e.g., pin, rod). These codes are not separately reportable if the removal is performed as a necessary integral component of another procedure. For example, if revision of an open fracture repair for nonunion or malunion of bone requires removal of a previously inserted pin, CPT code 20670 or 20680 is not separately reportable.
Similarly, if a superficial or deep implant (e.g., buried wire, pin, rod) requires surgical removal (CPT codes 20670 and 20680), it is not separately reportable if it is performed as an integral part of another procedure."

CCI Chapter Six
"12. CPT codes 43770-43774 describe laparoscopic gastric restrictive procedures. Only one of these procedure codes may be reported for a single patient encounter. If a patient develops a complication during the postoperative period of the initial procedure requiring return to the operating room for a different laparoscopic gastric restrictive procedure to treat the complication, the second procedure should be reported with modifier -78"
 
this helps soo much. its not on postop-or a complication. Wasn't "working for patient and she decided to try a bypass" Im going with bundled and thank you for giving me direction to look in!
 
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