Thursday, September 24, 2015

Diagnostic colonoscopy ; Adjustment of gastric band outside the 90-day global period of laparoscopic gastric band placement

Diagnostic colonoscopy -- revision to the Part B LCD
The local coverage determination (LCD) for diagnostic colonoscopy has been revised based on 2015 Healthcare Common Procedural Coding System (HCPCS) Annual Update. Under the “CPT®/HCPCS Codes” section of the LCD, Current Procedural Terminology (CPT®) codes 44401, 44402, 44403, 44404, 44405, 44406, 44407, 44408, 45388, 45389, 45390, 45393, and 45398 were added.

Effective date
This LCD revision is effective for claims processed on or after February 24, 2015, for services rendered on or after January 1, 2015.

Adjustment of gastric band outside the 90-day global period of laparoscopic gastric band placement

This article was developed to address recent inquires related to the adjustment of gastric lap band outside of the 90-day global period. Laparoscopic placement of an adjustable gastric band (LAGB) (CPT code 43770) is a covered procedure for surgical treatment of morbid obesity, when appropriate, based on the criteria outlined in the Medicare National Coverage Determination (NCD) for Bariatric Surgery for Treatment of Morbid Obesity (NCD 100.1) and local coverage determination (LCD) for Surgical Management of Morbid Obesity (L29317/L29477).

Adjustment of the gastric band after LAGB consists of an injection or withdrawal of saline. Adjustments to the LAGB should not be billed during the 90-day global period of the laparoscopic placement of an adjustable gastric band, as it is included in the primary procedure and is not separately payable during the global period.

Currently, adjustment of a LAGB does not have a unique CPT code. After the 90-day global period, it should be billed using CPT code 43659 (Unlisted laparoscopy procedure, stomach) with the statement “adjustment of gastric band” in Item 19 of the CMS-1500 or its electronic equivalent.
An evaluation and management (E&M) code and adjustment of LAGB will only be allowed on the same date of service if a significant separately identifiable and medically necessary service is provided. Modifier 25 should be appended to the E&M code only if it does not apply to the evaluation and adjustment of the LAGB.

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