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E&M coding for Lap-Band

  1. #1
    Default E&M coding for Lap-Band
    Medical Coding Books
    I need some help. Our surgeons are starting to do Lap-Band procedures. I need to know how to code the Initial consult. Do you guys code based on time or documentation. If you do it by time does the dr still need to do ROS? Because our doctor has done one and only documented psf history, and co-morbidities and exercise programs, etc.

    Any help would be appreciated.

    Stacey

  2. #2
    Default Um. no.
    Quote Originally Posted by asasands View Post
    I need some help. Our surgeons are starting to do Lap-Band procedures. I need to know how to code the Initial consult. Do you guys code based on time or documentation. If you do it by time does the dr still need to do ROS? Because our doctor has done one and only documented psf history, and co-morbidities and exercise programs, etc.

    Any help would be appreciated.

    Stacey
    First and maybe most importantly, a lot of payers are not covering the consultation codes so the rest of this assumes that you're talking about a payer that does.

    Now, when you say it's a consult, that means there is a "request for advice or opinion" in place. I've worked in bariatrics and most patients do not fit that bill. Most are self-referred for weight loss and there is no consultative nature to their visits.

    To address the coding based on time issue that is for when "counseling and coordination of care dominates more than 50% of the encounter" ONLY. To bill for services meeting that criteria the MD must document total time spent, total time spent counseling (to demonstrate the 50%) and summarize the content of the counseling (to be safe).

    A ROS on a patient presenting for any kind of surgery is just good medicine. In the case of a lap band patient, there are things that should definitely be reviewed not the least of which is constitutional (weight changes), musculoskeletal (weight bearing joint issues) and psychiatric (as at least some of these patients will need psych clearance prior to being approved by insurance for this surgery). From a medical necessity standpoint, you're going to want good documentation in order to get appeal should you not get paid. Bariatrics is particularly tricky.

    Hope this helps clear things up.
    Last edited by Belinda Frisch; 05-21-2010 at 03:20 PM.

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