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Any Bariatric Coders Out There?

  1. #1
    Location
    Winchester, VA
    Posts
    37
    Question Any Bariatric Coders Out There?
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    I work as a coder at a physicians billing office and we do the billing for a Bariatric program. I am new to coding for Bariatrics. Is there anyone that could give me some guidance on diagnosis coding for office visits? Are there any references available out there I could look at?

    I was under the assumption that if they were seeing a bariatric doctor, then the obesity code should always be listed first; why else would you be in a bariatric program? But, what diagnosis do you use when the patient comes back for their follow up visit (post gastric bypass)? Do you use the obesity code as primary or do you use a V code? What about for lap band adjustments? Is it based on the payer?

    Any help you could provide would be much appreciated.


    Thanks!
    Heather P.
    CPC

  2. #2
    Location
    Northeast Kansas AAPC
    Posts
    271
    Default
    For the initial visit and surgery you use the obesity CPT 278.01, the BMI, and co-morbidities. After they are out of the global package, for follow up visits use V45.86. If the patient has had a lap band and undergoes a fill or unfill then use V53.51. Medicare uses these diagnoses as of 10-1-10 - YEA!! Hope that helps.

  3. #3
    Location
    Johnson City
    Posts
    202
    Smile
    I agree with the diagnosis' given to you, but wanted to add. If the first fill is performed within the 90 global period to surgery, you can still bill for the fill use modifer 58. It is the doctor's plan to fill the band, on a later date. No reason why we should have to do the first fill for free.
    Melissa Jewett, CPC

  4. #4
    Location
    Northeast Kansas AAPC
    Posts
    271
    Default
    According to General Surgery Coding Alert/2009. Vol.II, No.8 if the patient is still within the global perfiod of the original surgery, adjustments fall within the global period postoperative management and you cannot separately report the service. In other words, there is no separate new payment for staged adjustments that fall within the surgical global period.

    CPT is clear about this guideline, stating "Typical postoperative follow up care ...after gastric restriction using the adjustable gastric restrictive device includes subsequent restrictive device adjustmentss through the postoperative period for the typical patient.

    Writer goes on to say: "Although I am sure it is possible to get these services paid using a modifier 58 or 78, it is inappropriate nd I would expect the insurer to ask for their money back on review.

  5. #5
    Location
    Winchester, VA
    Posts
    37
    Default
    Thanks for all the responses ! I appreciate all the insight. We are having trouble getting some office visits paid because some insurances pay for the 278.01 diagnosis but not the 278.00 or vice versa. The patient either loses or gains weight and the code changes to represent that and then the patient ends up complaining because insurance didn't cover the visit. They call and want us to change the diangosis code back LOL! Anyway, I am trying to learn all the in's and out's of Bariatric coding and it can be confusing at times.

  6. Default re bariatric
    i have worked denials for some bariatric surgeries and found the dx codes make a difference on the sequence.

    1st- obesity code
    2nd v code for BMI
    3 & 4 co-morbidity dx

    hope this helps

  7. Default
    Do you know how much Medicare will reimburse for a lap band adjustment?

  8. #8
    Location
    Quincy, MA
    Posts
    62
    Default
    Medicare will not accept S-code for lap band adjustment. We bill for it using E/M.

    http://www.medicarenhic.com/provider...cband_0807.pdf
    Leanne, CPC
    General/Vascular Surgery

  9. #9
    Location
    Johnson City
    Posts
    202
    Default
    You might want to check with your local Medicare carrier for a Bariatric Policy. local carrier"s (NGS Medicare-J-13) LCD states we should use the unlisted code 43999 for band adjustments.
    Melissa Jewett, CPC

  10. #10
    Location
    Northeast Kansas AAPC
    Posts
    271
    Default
    I agree with Melissa - we typically get paid $75 for adjustment of lap band from Medicare

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