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Olga Posted Wed 08th of June, 2011 22:50:23 PM

My physicians want to bill for all payers for lap band adjustments after bariatric surgery with the following codes.

43999 Band Adjustment
74246 Upper GI, barium swallow
76000 Fluoroscopy
Can any verify this or give me the guidelines as to why we should not?

SuperCoder Answered Thu 09th of June, 2011 14:45:06 PM

Gastric Band Adjustment
There is no specific code for an adjustment of the gastric band. Within 90 days of the original surgery, adjustments fall within the (bundled) global period for post-operative management. There is no separate new payment for staged adjustments that fall within the surgical global period.
Medically necessary adjustments outside the 90 day global period may be coded with CPT code 43999, unlisted
procedure, stomach. State "Gastric band adjustment” in the comment field for this unlisted code. Fluoroscopic guidance, if used, may be coded as CPT code 76000 {Fluoroscopy (separate procedure), up to 1 hour physician time}.
An E/M service may be charged (using modifier 25) if it is separately identifiable from the actual adjustment. For example, an appropriate evaluation of the patient’s new complaint(s) or management issues, interval history,
physical examination, medical decision-making, etc, is payable along with the adjustment procedure itself. If the patient had such a visit and decision-making previously, and is simply returning for the procedure, a separate E/M service should not be charged.

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