Gastric Bypass Codings Becoming More Common

As a medical biller, you may be seeing an increase in the number of gastric bypass claims that you are handling as more and more insurances are covering this procedure as a measure to remove the patient from danger of developing more serious, chronic and costly illnesses that can stem from being grossly obese.

After a patient has undergone gastric bypass surgery, eventually they will have the band removed. Many medical billing professionals are amiss at whether to include modifier 59 with their claim in order to obtain reimbursement for the procedure.

Under The Correct Coding Initiative (CCI), normally the procedure of removing the band and port removal would be bundled and reported using code (43774, Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components) to the gastric restriction (43644, Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy [roux limb 150 cm or less]).

The edit will already include a “1” modifier indicator, meaning you can append modifier 59 (Distinct procedural service) to report 43774 separately. But here is the hitch for this type of claim and the reason it is usually bundled, is because the surgeon would have to remove a previously placed adjustable band and port, if present, before performing the gastric bypass, which makes charging for the removal as a separate part of the procedure to put the band on when the gastric bypass was performed almost impossible.

The bottom line of this type of claims is that although Medicare and other carriers may pay for the initial procedure, they are normally going to expect the claim for removal of the gastric band to be a logical part of the procedure and in the majority of cases there will no separate reimbursement.

View all Articles by: Melissa Clark, CCS-P