Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures

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1 Surgeon and Radiological Services Billing for Laparoscopic Adjustable Gastric Band Procedures Table 1: Surgeon Billing for Laparoscopic Adjustable Gastric Band Procedures 2012 Medicare Payment Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band $1, Revision of adjustable gastric band, component only $1, Removal of adjustable gastric band, component only $ Removal and replacement of adjustable gastric band, component only $1, Removal of adjustable gastric band and subcutaneous port components $ Unlisted laparoscopy procedure, stomach* Carrier Priced Gastric restrictive procedure, open, revision of port component only $ Removal of subcutaneous port only $ Removal and replacement of subcutaneous port component only $455 * are codes physicians use during the 90-day global period, meaning the surgery payment includes related care provided for one day prior to the procedure, the day of the procedure, and 90 days following the procedure. Table 2: Surgeon Possible Billing for Adjustments and Possible Supply Codes Office or other outpatient visit - new patient Office or other outpatient visit - established patient Unlisted therapeutic, prophylactic or diagnostic intravenous or intra-arterial injection or infusion S2083 Adjustment of gastric band diameter via subcutaneous port by injection of aspiration of saline (HCPCS Level II) A Syringe with needle A4212 A4213 A4215 J2912 Non-coring needle or stylet, with or without catheter Syringe, sterile 20cc or greater each Needle, sterile, any size, each Injection, Sodium chloride, 0.9%, 2 ml *Codes for the adjustment of the band itself are typically done through an Evaluation & Management (E&M) code applicable to the level of service provided, with the appropriate ICD-9-CM code. *Supply codes are generally not paid separately and are considered bundled codes. *E&M codes, consultations, and subsequent visit codes may be used after the 90-day global period. Page 1 of 5

2 Table 3: Radiologist and/or Surgeon Global Billing (Procedure performed in physician-owned office and clinic) Fluoroscopic guidance for needle placement (e.g., biopsy aspiration, injection, localization device) Radiologic examination, gastrointestinal tract, upper; with or without delayed films, without KUB Radiologic examination, gastrointestinal tract, upper; with or without delayed films, with KUB Radiologic examination, gastrointestinal tract, upper, air contrast, with specific high-density barium, effervescent agent, with or without glucagons; with or without delayed films, without KUB Radiologic examination, gastrointestinal tract, upper, air contrast, with specific high-density barium, effervescent agent, with or without glucagons; with or without delayed films, with KUB Radiologic examination, abdomen; single anteroposterior view Fluoroscopy (separate procedure), up to 1 hour physician time, other than or (e.g., cardiac fluoroscopy) Disclaimer: This abridged version of the 2012 CPT codes is taken from those issued by the federal government. It contains many of the more frequently used codes; however, the ultimate responsibility for correct coding lies with the provider of services based on documentation in the patient s medical record. Page 2 of 5

3 Facility Billing for Laparoscopic Adjustable Gastric Band Procedures Table 4: Hospital ICD-9-CM Procedure Codes for Laparoscopic Adjustable Gastric Band Procedures ICD-9-CM Laparoscopic gastric restrictive procedure; adjustable gastric band and port insertion Laparoscopic revision of gastric restrictive procedure revision or replacement of adjustable gastric band subcutaneous gastric port device Laparoscopic revision of gastric restrictive procedure removal of either or both: adjustable gastric band; subcutaneous gastric port device Laparoscopic adjustment of size of adjustable gastric restrictive device; infusion of saline for device tightening; withdrawal of saline for device loosening Other operations of the stomach 88.1x Other X-ray of the abdomen 87.6x Other X-ray of the digestive system Table 5: Hospital ICD-9-CM Diagnosis Possible Complication Codes for Laparoscopic Adjustable Gastric Band Procedures ICD-9-CM Other internal complications due to unspecified device, implant, and graft Mechanical complications due to other implant and internal device, not elsewhere classified nonabsorbable surgical material Infection and inflammatory reaction, due to other internal prosthetic device, implant, and graft The table below shows a sample of Medicare diagnosis related groups (DRGs) associated with LAGB. Actual facility DRG payment is dependent on varying geographical, diagnosis procedure case mix associated with each Medicare inpatient admission at the time of discharge. Table 6: Possible DRG Mapping for Fiscal Year 2012 (Oct. 1, Sept. 30, 2012) DRG Medicare Payment 619 O.R. Procedure for Obesity with MCC $19, O.R. Procedure for Obesity with CC $10, O.R. Procedure for Obesity without MCC or CC $8,354 Page 3 of 5

4 In addition to ICD-9-CM procedure codes, hospitals also must report revenue codes. Table 7 lists sample revenue codes that may be associated with LAGB procedures. This is not an all-inclusive list of available revenue codes. Specific revenue codes selected will be determined by facility policies and procedures for billing medical services. It is recommended to review payor-specific billing guidance and facility contracts for specific payor-directed revenue codes. Table 7: Possible Revenue Codes Revenue Code 27x Supply 36x 37x Operating room services Anesthesia It is also permissible and often recommended to submit secondary diagnosis codes. Secondary diagnosis codes include V-codes, which classify circumstances other than a disease or injury into categories. V-codes associated with patients receiving LAGB are listed below. Table 8: Possible ICD-9-CM Diagnosis Codes ICD-9-CM xx Diabetes mellitus Morbid Obesity Sleep Apnea 401.x Essential Hypertension 462 Sore Throat Reflux Infection due to Gastric Band procedure Other complication of Gastric Band procedure Infection due to other Bariatric procedure Other complication of other Bariatric procedure Overeating Hoarseness Wheezing Chronic Cough Regurgitation Heartburn Belching Other digestive system complication Page 4 of 5

5 Table 9: Possible ICD-9-CM Diagnosis Codes (V-codes) ICD-9-CM 3 V12.29 Personal history of other endocrine, metabolic, and immunity disorders V85.0 Body Mass Index less than 19, adult V85.1 Body Mass Index 19 to 24, adult V85.21 Body Mass Index 25.0 to 25.9, adult V85.22 Body Mass Index 26.0 to 26.9, adult V85.23 Body Mass Index 27.0 to 27.9, adult V85.24 Body Mass Index 28.0 to 28.9, adult V85.25 Body Mass Index 29.0 to 29.9, adult V85.30 Body Mass Index 30.0 to 30.9, adult V85.31 Body Mass Index 31.0 to 31.9, adult V85.32 Body Mass Index 32.0 to 32.9, adult V85.33 Body Mass Index 33.0 to 33.9, adult V85.34 Body Mass Index 34.0 to 34.9, adult V85.35 Body Mass Index 35.0 to 35.9, adult V85.36 Body Mass Index 36.0 to 36.9, adult V85.37 Body Mass Index 37.0 to 37.9, adult V85.38 Body Mass Index 38.0 to 38.9, adult V85.39 Body Mass Index 39.0 to 39.9, adult V85.4 Body Mass Index 40 or greater, adult V53.90 Fitting and adjustment, unspecified device V53.99 Fitting and adjustment, other device 1 All Current Procedural Terminology (CPT) five-digit numeric codes, descriptions, numeric modifiers, instructions, guidelines and other material are copyright 2011 American Medical Association. All Rights Reserved. 2 Federal Register, Vol. 76, No. 228, Monday, November 28, 2011/Rules and Regulations. The 2012 Final Physician Reimbursement Conversion Factor = $ ; Federal Register. 3 Hospital ICD-9-CM 2010 Volumes 1, 2 & 3, 9th Revision-Clinical Modification, American Medical Association. Copyright 2011 Saunders, an imprint of Elsevier, Inc. 4 Federal Register, Vol. 76, No. 160, Thursday, August 18, 2011/ Rules and Regulations; Final National Average DRG Payment. Physicians should refer to their provider Carrier Manual for their geographic payments. The information contained in this document is provided to help you understand the reimbursement process. It is not intended to increase or maximize reimbursement by any payor. We strongly recommend that providers consult their payor organization with regard to local reimbursement policies. The information contained in this document is provided for information purposes only and represents no statement, promise or guarantee by Ethicon Endo-Surgery, Inc. concerning levels of reimbursement, payment or charge. Similarly, all CPT, HCPCS and ICD-9 codes are supplied for information purposes only and represent no statement, promise or guarantee by Ethicon Endo-Surgery, Inc. that these codes will be appropriate or that reimbursement will be made. ICD-9 is based on the official version of the World Health Organization s Ninth Revision, International Classification of Diseases. CPT codes and descriptions only are copyright 2011 American Medical Association. All Rights Reserved. CPT does not include fee schedules, relative values or related listings. The source for this information is the Centers for Medicare and Medicaid Services and various commercial payors. The content provided by the Centers for Medicare and Medicaid Services is updated frequently. It is the responsibility of the health services provider to confirm the appropriate coding required by their local Medicare carriers, fiscal intermediaries and commercial payors. Page 5 of Ethicon Endo-Surgery, Inc. All rights reserved. DSL: AGB

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