Wiki Gastric Banding and Hernia Repair combined

[jaldrich]

I have sent this by private message to a couple of people, but I'd like to run it past the group. I have an ASC in our facility. We also have a physician who performs Lap Gastric Bandings for obesity. Most insurances seem to have a contract exclusion for obesity, so patients pay cash for these procedures. The doctor has lately started repairing Diaphragmatic hernias (553.3) while in performing the band. I'm wondering what kind of billing should take place? We've been billing the patient directly for the lap band, but now the doctor is trying to provide another anesthesia code and lap repair codes for the hernia along with dx 553.3. It seems to me that an insurance with an exclusion for obesity wouldn't want to pay for the hernia repair if it was incidental to the obesity surgery...am I incorrect? Should we be billing the patient for all elements of the surgery? Billing the insurance for all elements? or just billing the hernia to insurance and the lap band to the patient?
Thank you,
Jennifer

 

[m6scott]

My doc, on cash patients is still providing the repair but we are not billing out the repair to the insurance company. We eat that piece. But, on the insurance lap band patients we bill the whole thing and are being reimbursed for the secondary procedure. We are getting paid by the way by a few payors for the lap band, but finding just as many exclusions as you seem to be finding.