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General Surgery Coding Alert

Bariatric Surgery Code Overhaul: The Laparoscopic Banding Code You've Waited for is Here

- Published on Sun, Jan 01, 2006
"Apply modifier 52 with 43770 for placement of an individual component

After years of reporting an unlisted-procedure code--with all its attending documentation complications--you can now select a dedicated CPT code for laparoscopic banding gastric restrictive surgery. In addition, you-ll have new codes to describe open revisions and removal of the subcutaneous port. Familiarize Yourself With the New Codes Instead of unlisted-procedure code 43659 (Unlisted laparoscopy procedure, stomach), you can now report 43770 (Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band [gastric band and subcutaneous port components]) for laparoscopic band procedures

How it works: During the procedure, the surgeon--using laparoscopic techniques--places an adjustable silicone band just below the gastroesophageal junction, says  Giselle G. Hamad, MD, FACS, assistant professor of surgery at the University of Pittsburgh. The band connects to an access port, into which the surgeon may inject (or aspirate) saline to expand (or contract) the band and effectively manipulate stomach size (and thus, control appetite suppression, satiety and weight loss).

Because the surgery requires the physician to place both the adjustable band and subcutaneous port, CPT has included several companion codes for 43770 to describe subsequent revision or removal of the individual components, including:

- 43771---revision of adjustable gastric band component only
- 43772---removal of adjustable gastric band component only
- 43773---removal and replacement of adjustable gastric band component only
- 43774---removal of adjustable gastric band and subcutaneous port components. You should not report 43772 and 43773 for the same session. Removal and replacement of the gastric band (43773) includes removal as described by 43772. Don't Confuse Revisions and Adjustments Although appropriately applying 43771-43774 is mostly self-explanatory, you must be careful to make one distinction: Gastric band adjustments (by saline injection or aspiration) are not the same as revisions as described by 43771, Hamad says.

The surgeon performs -adjustments- routinely  (generally in the office) several times a year to optimize weight loss. You should include such adjustments to the gastric band by saline injection/aspiration (which is a nonsurgical procedure) as a standard postoperative component of 43770 and 43773, according to CPT rules and the AMA's CPT Changes 2006: An Insider's View.

In other words: You cannot report a separate service for band adjustments during the primary procedures- global period.

On the other hand, gastric band revision (43771) involves laparoscopic surgery to manipulate a gastric band placed during a previous procedure. Such revisions are not routine, and a surgeon would only undertake such a procedure to manage a complication, Hamad says. Modifiers, Unlisted Codes Make Up for Gaps In two circumstances, you still cannot call on a dedicated CPT code to describe a procedure associated with laparoscopic gastric banding, Hamad says. These include placing either the gastric band or the subcutaneous port components only, or removing and replacing [...]

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CPT® Code 43774 Details
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