Bariatric surgery w/ hiatal hernia

herrera4

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I usually code basic general surgery so i am unclear on specifics for bariatric cases-any info is appreciated

Mainly-can you bill a hiatal hernia repair with a lap bypass or sleeve? My coding software says no but my physician says yes! it does say modifier 59 allowed but i dont see it as qualifying for that. i would love anyones opinions on this or any websites, info, or tips on anything bariatric. I'm by myself and sometimes feel like im giving dr.s wrong info

thank you
 

cgaston

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Whoo boy! This brings back some traumatic memories. I spent the better part of last year researching this and going back and forth with our Bariatric Physicians.

Their rationale is that it is considered best medical practice to correct the hernia while they are already in the area. It is best practice but best practice isn't always separately payable!

CPT 43281 is separately payable when performed with a bariatric procedure, CPT 43280 is not. The difference between the two codes is that in 43281 the hernia sac is removed and then the area is repaired; in 43280 the hernia is only repaired via sutures.

We cited this:

https://asmbs.org/wp/uploads/2015/10/NCCI-PTP-edit-2015-Final.pdf

and this:

https://asmbs.org/articles/insurance-committee-coding-alert-hiatal-hernia-repair-cpt-43280-may-2013


And after some deliberating we implemented that if a hernia sac was removed and sent to pathology (and there was a pathology report) then we would bill for a hernia repair in addition to the bariatric procedure. If only a suture repair was done we would not code for the 43280 per the NCCI Edits.

I hope your group can come to an amicable solution as well!
 

herrera4

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thank you

I cant tell you how much this helps!! thank you so much-after review of this vs. op notes-it certainly wasnt billable. thank you again!:eek::eek:
 

herrera4

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how about this

if your feeling up to it

how about revision-when he takes out a band and does bypass he wants 2 codes billed-but again i see as bundled? what would be best coding for that?
 

cgaston

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Looks like 43774 is separately billable with the laparoscopic Roux-en-Y (43644) but not the open procedure (43846).

So I guess if he wants to bill for both he is going to have to do the conversion laparoscopically! ;)

I would show him the NCCI edits and tell him that billing them together could open him up for an audit (no one likes to hear the word "audit"). Good luck!
 

LMCODER

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band removal w sleeve

It is my understanding that although a gastric band removal does not bundle with a sleeve gastrectomy it would not be appropriate to bill this as the band needs to be removed to complete the sleeve gastrectomy.
 
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