Lap Band Adjustments

[cmartin]

Any ideas on how to code lap band adjustments which are NOT during "the postop period for the typical patient"?
Thanks

 

[leigh0114]

My group is using S2083 or 90779 depending on the patients insurance coverage.

Hope this helps!

 

[TammyM]

We are using cpt 90779. It is our practice to make all or our pts self pay for the band adjustments. Are you finding some insurances are paying? What about medicare?

 

[m6scott]

My group is billing an unlisted code, since its basically a fill with saline we used the injection of saline as a mirror type code. But, to be honest we are collecting cash for all adjustments and/or fills as sadly the insurance companies will pay for the implant but not the adjustments..crazy.

 

[cmartin]

Thank you everyone!
C.Martin

 

[mjewett]

What is a ballpark price for lap band fills? Since using an unlisted code not sure what to base it from.
Thanks
Melissa

 

[sundaey]

we charge $100 for the lap band fill for cash pay patients. For our ins. pt's, we are coding out the o/v.

 

[cmartin]

We're charging $145; we've had a few insurances pay - some @ $139.80, one @ $123.25. We have a lot outstanding, so I'll update if we get any new results worth mentioning.
Connie Martin CPC

 

[sgarner]

We are using the S2083 as well but what are you using for Medicare Patients and what dx codes are you using? 278.01 and v45.86, i wondered about
V53.99 as well?

 

[ARCPC9491]

we just bill the S2083 - the program is just starting..so no Medicare patients yet, not center for excellence...I wonder what you would bill for Medicare..they probably wouldn't cover it anyway.. LOL..I guess you could pull up the LCD for the bypass codes... they sometimes link other codes in the LCD that have to do with the bypass. We always 278.01 for the dx plus the V code for bypass status...

we charge $250.. we've actually had BCBS pay about $150. Aetna allows an unlimited amount of adjustments within the global...which is odd...and they pay a little over $200 for each. We really haven't done that many cases..hopefully the volume will pick up soon..but some plans just won't pay and we are making patients pay - they of course seem to have no objection to it given it's an elective procedure anyway.

OH - one last thing.. one of the docs always wanted to bill the 90772 w/ the S2083 - (if they are filling) but I read somewhere that is NOT proper - the S2083 takes care of it completely (whether you are filling or reducing the band) I didn't see this on the post, but just thought i'd throw it out there.


hope that helps....

 

[ProfessionalCoder]

Any ideas on how to code lap band adjustments which are NOT during "the postop period for the typical patient"?
Thanks

I have been getting paid by using and e/m code with modifier -25 and the
S2083 Medicare is the only insuance that I have not had to bill to with this but BCBS, BCN and most comericals have been paying. cshaw