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Bariatric Surgery Question

  1. #1
    Question Bariatric Surgery Question
    Medical Coding Books
    I have a provider who removed a Lap Band (43774) and then performed a Gastric Bypass
    (43644). When discussing this case with the doctor he feels we should use a revision Gastric Bypass code (43848), however this patient has never had a Gastric Bypass before. Wouldn't it be appropriate to use CPT 43644?????

    I hate to challenge the doctors but this one I have to have all my ducks in a row before reviewing it with him again. Also... he likes to bill what ever gives the highest RVU lets just say it makes me cringe when he says that. It does not matter it is what you perform....(done venting now!)

    dlm

  2. #2
    Location
    Northeast Kansas AAPC
    Posts
    275
    Default
    The definition in Coder's Desk Reference to CPT code 43848 reads "the physician uses an open technique to revise a failed gastric restrictive procedure for morbid obesity. Indications for revision include stomal stenosis, stomal dilatation, non-emptying gastric pouch, GERD, staple dehiscence, intragastric foreign body, gastric fistula, failure to maintain weight loss, breakdown of staple continuity and restrored gastric continuity. This code is not used to report revision of an adjustable gastric device."

    I agree that you would use 43644 for a Roux-en-Y and if the band is removed at the same time as the Roux-en-Y you cannot bill for the removal of the band plus the Roux.

    Hope that helps.

  3. Thumbs up
    Quote Originally Posted by dmaguire View Post
    I have a provider who removed a Lap Band (43774) and then performed a Gastric Bypass
    (43644). When discussing this case with the doctor he feels we should use a revision Gastric Bypass code (43848), however this patient has never had a Gastric Bypass before. Wouldn't it be appropriate to use CPT 43644?????

    I hate to challenge the doctors but this one I have to have all my ducks in a row before reviewing it with him again. Also... he likes to bill what ever gives the highest RVU lets just say it makes me cringe when he says that. It does not matter it is what you perform....(done venting now!)

    dlm
    This is where the problem is do you agree or disagree with the doctor. This is fraud already.
    Thanks, SAUKA

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