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For other articles and previous issues click here. May 31, 2004 Coding
for Laparoscopic Adjustable Gastric Banding On December 4, 2003, the Centers for Medicare & Medicaid Services (CMS) proposed new procedure codes at the ICD-9-CM coordination and maintenance (C&M) committee meeting to classify laparoscopic adjustable gastric banding, a weight-loss surgical procedure performed to treat morbid obesity. Currently, this procedure is classified to code 44.69, Other repair of stomach, which also includes several other weight-loss restrictive operations. Laparoscopic adjustable gastric banding involves the insertion of an inflatable silicone band through a laparoscopic technique around the stomach near its upper end, creating a small pouch and a narrow passage into the remainder of the stomach. Therefore, the patient is satisfied with smaller amounts of food. There is no cutting, staples, or bypass involved in this procedure. An access port is secured to the abdominal wall fascia, which allows the physician to inject a salt solution through the access port to inflate the band. The patient may be admitted for a 23-hour stay or remain in the hospital for up to two nights. After the original insertion, the patient may require several outpatient visits so the band may be adjusted until it is functioning optimally. The band may be tightened or loosened by adjusting the amount of salt solution in the band. Since this procedure does not require permanent alterations to the stomach, the procedure can be surgically reversed. After the band is removed, the stomach will likely return to its original form and capacity. Proposed Codes If the above codes are approved, they will become effective with discharges on or after October 1, 2004. Until then, coders should continue to use code 44.69 for the laparoscopic adjustable gastric banding procedure. Other Restrictive Operations Obesity Morbid obesity (278.01) is diagnosed when the patient
weighs two or more times his or her ideal body weight, when the
patient is 100 pounds over his or her ideal body weight, or when
the BMI is 40 or more. Six million Americans are considered morbidly
obese. It is named “morbid” obesity because it is associated
with many life-threatening diseases. “Mortality and morbidity
from most diseases, accidents, and injuries are significantly higher
among obese persons and increase with the magnitude of the obesity”
(The Merck Manual, 16th edition, page 984). Some conditions
associated with obesity are the following: If a patient has tried diet and exercise but still has a BMI of 40 or more, then weight loss (bariatric) surgery may be an option. Coding and sequencing for laparoscopic adjustable gastric banding are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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