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Lap Band Fill

  1. #1
    Location
    Winchester, VA #54042
    Posts
    8
    Default Lap Band Fill
    Exam Training Packages
    I've been told we cannot bill Medicare for lap band fills as of Feb 2011, even after the global period. Is this true? I'm billing GA Medicare.

  2. #2
    Location
    Northeast Kansas AAPC
    Posts
    271
    Default
    You can only bill Medicare for lap band fills after 90 days. Bill 43999 with your price and put in narrative "lap band adjustment". Now the only diagnosis you need is V53.51. There is also a 10 day global on adjustments. If you see the patient within 90 days of an adjustment and you do not do an adjustment you can charge for office visit with a 24 modifier and diagnosis of C4-5/86. Hope that helps.

  3. #3
    Location
    Winchester, VA #54042
    Posts
    8
    Default
    Thank you for your reply, but my supervisor is telling me we cannot bill after the 90 days, and 43999 is no longer valid. I asked for a reference, but did not get a clear reponse. The only thing I'm finding in reference to the Feb 2011 is a LCD that states you can't bill within the 90 day global period. And I'm kind of stuck because this is a new clinic I'm billing for, and don't know how it was billed before. Can anyone verify they are getting paid for lap band fills after the 90 global period for DOS March 2011 going forward? This would help me tremendously!!

  4. #4
    Default
    I agree with Lindacoder. Bill 43999 for medicare with notes for lap band fill after post-op period.
    K-CPC

  5. #5
    Location
    Northeast Kansas AAPC
    Posts
    271
    Default
    If you go to Medicare's website and look in the NCD's it will bring up bariatric surgery. From there you can go to "coding bariatric" and scroll down. It says you cannot bill 43999 during the post op period but can after the 90 days. It explains how Medicare wants all procedures done. This was updated Oct. 2010 and I have not had any problems getting adjustments paid after the 90 days. Hope this helps.

  6. Default
    I just checked website & it has updates thru May (which was just to remove a jurisdiction they no longer are carrier for), but 43999/V53.51 stands unchanged.

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