CPT Codes - American Society for Metabolic & Bariatric Surgery



CPT? and ICD-9 Codes for Bariatric Surgery Presented by the ASMBS Insurance CommitteeCPT? and ICD-9 are dictated by payer policy guidelines. These codes are for reference only. Disclaimer: The coding, billing and reimbursement of any medical treatment or procedure is highly subjective, and is dependent upon the interpretation of multiple variables, to include differing Medicare fiscal agent Local Coverage Determinations, and a wide variety of commercial insurance payers' policies. American Society for Metabolic and Bariatric Surgery (ASMBS) presents the information in this guide only as general information and a point of reference. ASMBS does not and cannot guarantee or warranty that the reliance upon any information presented in this guide will result in any provider's compliance with a particular payer's coding, billing or reimbursement requirements. This guide does not and cannot constitute professional advice or be a substitute for applicable professional advice regarding the coding, billing or reimbursement for any specific circumstance. ASMBS highly recommends that every provider consult a coding, billing or reimbursement professional regarding the submission of any specific claim for reimbursement."** Converts approximately to. See addition code selections for specificityOpen ProceduresOperationDescriptionCPT? CodesFacility Procedure CodeICD-10 PCSVBGGastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty4384244.680DQ64ZZ**AGBGastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty4384344.690DQ60ZZ**BPD/DSGastric restrictive procedure, with partial gastrectomy, pylorus-preserving duodenoileostomy (50 to 100 cm common channel) to limit absorption (BPD/DS)4384545.9143.8945.510D190Z9**0DB60ZZ**0DB80ZZ **RYGB (proximal)Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (less than 150 cm) Roux-en-Y gastroenterostomy4384644.390D16078**RYGB (distal)Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption4384744.390D16078 **Revision RYGBRevision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)4384844.50DQ60ZZ**BPDGastrectomy, partial, distal; with Roux-en-Y reconstruction4363343.70DB60ZZ**Laparoscopic Bypass ProceduresOperationDescriptionCPT? CodesFacility Procedure CodeICD-10 PCSRYGB (proximal)Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en Y gastroenterostomy (Roux limb 150 cm or less)4364444.380D16479**RYGB (distal)Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption4364544.380D16479** Lap DS, Lap revisionsLap sleeve gastrectomyUnlisted laparoscopy, stomach4365943.890DB60ZZ**Laparoscopic Gastric Restrictive ProceduresOperationDescriptionCPT? CodesFacility Procedure CodeICD-10 PCSLap adjustable gastric band and port implantationImplantation of adjustable gastric band and port, [Laparoscopic]4377044.950DV64CZLap Sleeve GastrectomyLaparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy)4377543.890DB60ZZ**ZZAdjustable Gastric Band and Subcutaneous Port[Implantation]DescriptionCPT? CodesFacility Procedure CodeICD-10 PCSImplantation of adjustable gastric band and port, [Laparoscopic]4377044.950DV64CZRestrictive Procedure, non-VBG,[Open]4384344.690DQ60ZZ**Adjustable Gastric Band and Subcutaneous Port[Other]DescriptionCPT?CodesFacility ProcedureCodeRemoval of adjustable gastric band and port4377444.970DP643Z**Replacement of gastric band and port4365944.960DW643Z**Adjustable Gastric Band OnlyDescriptionCPT? CodesFacility Procedure CodeRevision of gastric band4377144.960DW643Z**Removal of gastric band4377244.970DP643Z**Removal and replacement of gastric band43773*44.970DP643Z**Implantation of gastric band/subcutaneous port(for individual component placement report modifier -52)43770-5244.9544.9844.9644.9944.970DV64CZ3E0G3GC0IDW643Z **0DQ67ZZ**0DP643Z***Can’t use 43773 if you use 43772Subcutaneous Port OnlyDescriptionCPT? CodesFacility Procedure CodeICD-10 PCSRevision of subcutaneous port, Open4388644.6944.990DQ60ZZ**0EQ67ZZ**Removal of subcutaneous port, Open4388744.990DQ67ZZ,0DQ68ZZRemoval and replacement of subcutaneous port, Open43888*44.990DQ67ZZ,0DQ68ZZ(Laparoscopic) adjustment of size of adjustable gastric restrictive device. Infusion of saline for device tightening/ withdrawal of saline for device looseningCode also any:Abdominal ultrasound FluoroscopyBarium swallowS2083767007700244.9888.7488.7688.1987.613E0G3GCBD47ZZZ **BW40ZZZBW0ZZZ**BD11YZZ*Can’t use 43888 if you use 43887 or 43774** Converts approximately to. See addition code selections for specificity RevisionsDescriptionCPT? CodesFacilityProcedure CodeLaparoscopy, unlisted stomach4365944.960DQ60ZZ**Revision of band to RYGB, Laparoscopic *multiple surgery rule4364443774-5144.3844.9744.990D13479**0DP643Z**0DQ67ZZ**Removal of band to RYGB, Open4384844.50DQ60ZZ**Placement of band for revision of RYGB, Laparoscopic (Increased Procedural Services)43770-22*44.950DV64CZRevision of sleeve gastrectomy to RYGB, Laparoscopic(Increased Procedural Services)43644-2243.38Revision of subcutaneous port, Open4388644.6944.990DQ60ZZ**0DQ67ZZ**Revision of gastric band4377144.960DW643Z**Laparoscopic removal of band andRevision Laparoscopic sleeve gastrectomy43774-51*4377544.9743.890DP643Z**0DB60ZZ**Always list the most resource-intensive (expensive) procedure first, without a modifier*Increased procedural service. When the work required to provide a service is substantially greater than typically requiredOther Options during Revisional ProceduresRevision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric band (separate procedure)4384844.50DQ60ZZ**Revision of gastroduodenal anastomosis (gastrojejunostomy) with reconstruction, with or without vagotomy4385044.0044.0344.0144.544.02008Q0ZZ**008Q0ZZ**008Q0ZZ**0DQ60ZZ**008Q0ZZ**Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastectomy or intestine resection; without vagotomy4386043.744.0244.0044.0344.0144.390D60ZZ**008Q0ZZ**008Q0ZZ**008Q0ZZ**0DQ60ZZ**0DT60ZZ**Enterectomy, resection of small intestine; single resection and anastomosis4412045.6146.0245.6246.0346.0146.200DB80ZZ**0DB87ZZ**0DT90ZZ**0D1K0Z4**0D190Z4**0D1B0Z4**Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis4420245.620DT90ZZ**Unlisted laparoscopy procedure, intestine4423845.2845.2946.640DJD3ZZ**0DJD3ZZ**0DSH0ZZ**Excision, local; ulcer of stomach4361043.420DB60ZZ**Reduction of volvulus, intussusceptions, internal hernia, by laparotomy4405046.8146.8254.950DS90ZZ**0DSH0ZZ**0W9J00Z**Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion)4418054.510DN84ZZ**Other OptionsSuture of mesentery (separate procedure)4485054.750DQV0ZZ**Cholecystectomy4756251.2351.240F744ZZ0FB44ZZRepair, paraesophageal hiatus hernia, transabdominal, with or without fundoplasty, vagotomy, and/or pyloroplasty, except neonatal3950253.71 53.72 53.7544.0044.2944.690BQR4ZZ**0BQR0ZZ**0BQR0ZZ**008Q0ZZ**0DQ70ZZ**0DQ60ZZ**Unlisted procedure, diaphragm3959934.2834.8334.8553.7153.7553.82 53.830BJQ0ZZ**0BQR0ZZ**0BHR0MZ**0BQR4ZZ**0BQR0ZZ**0BQR0ZZ**0BQR4ZZ**Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet procedures)* Note is crural repair only is done, append modifier -52 (reduced services) 4328042.744.6544.6644.670D840ZZ**0DQ40ZZ**0DV40CZ**0DV44CZ**Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; without implantation of mesh43281Laparoscopy, surgical, repair of paraesophageal hernia, includes fundoplasty, when performed; with implantation of mesh43282AdjustmentsDescriptionCPT? CodesE & M Establish patient99211 - 99215New Pt. had band placement performed by surgeonNot performing the adjustment – E & M 99201 -99205Fluoroscopic guidance for needle placement (aspiration, injection, localization of device) Modifier(s) may apply (when performed in combination with Radiologist)77002-26/TCUltrasonic guidance for needle placement (e.g. Biopsy, aspiration, injection, localization devise), imaging supervision and interpretation76942Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed films, without KUB74246Lap-Band Adjustment only *(payer discretion)S2083**Office visit and Lap-Band AdjustmentDecision for adjustment must be made on the same day of adjustment(follow appropriate coding rules for modifier -25)99211-99215-25S2083**S codes are national codes (non-Medicare) created by the Blues which other payers have adopted.* If the payer does not recognize S2083, these are alternative codes to use:Unlisted Procedure of the stomachUse when there is no payer designated CPT? codeIn the comment field on your CMS 1500 form (box 19)Type “Gastric Band Adjustment”43999* code maybe subject to global period, payer discretion Office visit and Injection(decision for adjustment must be made on the same day of adjustment)if the sole purpose for the visit is adjustment an E & M code cannot be billed99211-99215-2543999Miscellaneous Supply codesMay NOT be billed with S2083 codePsychology CodingOriginal Code - 2012New CPT? Crosswalk 2013Service DescriptionComments9080190791 Psychiatric diagnostic evaluationModifier -AH? no longer required for Medicare. This code to be used for Psychologist only9080190792Psychiatric diagnostic evaluationThis code to be used for prescribing medical providers only i.e. MD/DO, PA, APRN?9601096010Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, e.g., MMPI, Rorschach, WAIS), per hour of the psychologist’s or physician’s time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report9080490832Psychotherapy, 30 minutes9080790834Psychotherapy, 45 minutes9080890837Psychotherapy, 60 minutesPrior authorization maybe requireImportantly, these 2013 coding changes involve only the psychotherapy codes – the codes found in the Psychiatry section of the 2013 CPT? manual. There are no changes to other codes that psychologists use, such as testing or health and behavior codes. Bariatric ICD-9-CMDiagnostic Codes by Body SystemCardiovascular SystemICD-10Hypertensive heart disease402.00 - 402.91I11.9 - I11.0 – Reference Chp 9 guidelines for code setsHypertensive chronic kidney disease403.00 - 403.91I12.9 – I12.0Hypertensive Heart and Chronic kidney disease404.00 - 404.93I13.10 – I13.2Cardiovascular disease, unspecified429.2I25.10Cardiovascular disease – Family HxV17.49Z82.49Congestive heart failure – unspecified428.0I50.9 – I50.43Coronary atherosclerosis, unspecified 414.XX (needs 4th and 5th digit)I20 – I25Heart attack – unspecified 410.9 needs 5th digit No longer existsHypertension – benign401.1I10 – I15Hypertension – malignant401.0I-10 – I15Post phlebitic syndrome – w/o complication459.10I87.009 – I87.003Varicose veins – NOS454.9I83.9 – I83.93Circulatory SystemVenous insufficiency (peripheral) – unspecified459.81I87.2 – I87.9Endocrine System Code RangeSecondary Diabetes Mellitus without mention of complication, not stated as uncontrolled, or unspecified249.00 - 249.91E08.9 – E13.9Diabetes Mellitus type II controlled250.00E11.9 – E13.9 Diabetes Mellitus type II uncontrolled250.02E11.65Hypercholesterolemia272.0E78.0Hyperlipidemia272.2E78.2Hyperlipidemia other and unspecified272.4E78.4 – E78.5Hypertriglyceridemia, essential272.1E78.1Hypothyroid – NOS244.9E09.9Overweight - BMI 25-30278.02*E66.3**Obese - class I - BMI 30-35278.00*E66.9 – E66.09, E66.1, E66.8 **Severely obese - class II - BMI 35-40278.01*E66.01 (read guideline) **Super obese - class III - BMI over 40278.01**Use additional code to identify Body Mass Index (BMI) if known(V85.21 – V85.4)See code specifics below under BMIBMI adult codes are fore persons over 20 years oldV85 – V85.4BMI pediatric codes are for use for persons age 2-20 years oldV85.51 – V85.54*Some Medicare Administrative Contractors (MAC) requires use of 278.00 for BMI’s of 35-39.9. Providers should check the billing guidelines by the MAC in their state for lower BMI criteria.*When listing 278.00 and 278.01, report the BMI with an additional V code** ICD-10 Overweight, obesity and other hyperalimentation (E65-E68)Gastrointestinal SystemCholelithiasis574.20K80.20 – K80.80Cholecystitis – unspecified575.10K81.9Difficulty swallowing/Dysphagia787.2R13.0 – R13.10 – read specific guidelines for use of dysphagiaGastroesophageal Reflux Disease(G.E.R.D.)530.81K21.9Heartburn787.1R12Barrett’s Esophagus530.85K22.70, K22.710, K22.711, K22.719Hepatitis – unspecified573.3K71.0 – K75.9 addtl digits maybe requiredHernia – Hiatal553.3K44.9Hernia – Incisional553.21K43.2Hernia – Ventral - unspecified553.20K43.9Genitourinary SystemFrequent urination788.41R35.0Urinary stress incontinence – Female625.6N39.3Urinary stress incontinence – Male788.32N39.3Gynecologic problems (Female)Amenorrhea626.0N91.2, N91.0, N94.1Heavy periods626.2N92.0Infertility – unspecified628.9N97.9Irregular periods626.4N92.5, N92.6Dysmenorrhea – Painful periods625.3N94.6, N94.4, N94.5Polycystic ovary disease256.4E28.2Musculoskeletal SystemDegeneration intervertebral disc722.51 - 722.93M51.34, M51.35 – M46.47, M51.86, M51.87, M46.46 Osteoarthrosis, localized, primary 715.10 – 715.18M00 – M25 (Arthropathies)Osteoarthrosis, localized, secondary715.20 – 715.28M00 – M25 Osteoarthrosis, localized not specified as primary or secondary715.35 – 715.38 M00 – M25 Read coding guidelines Arthritis – weight bearing joints716.98M12.9Joint pain – weight bearing joints719.49M12.89Joint pain – Back719.48M12.88Joint pain – Foot719.47M12.879, M12.871, M12.872Joint pain – Hip719.45M25.559, M25.551, M25.552Joint pain – Knee719.46M25.569, M25.561, M25.562Low back pain724.2M54.5Sciatica724.3M54.30, M54.31, M54.32, M54.40, M54.41, M54.42Swelling of ankles719.07M25.473, M25.476, M25.471, M25.472, M25.474, M25.475Respiratory SystemAsthma – unspecified493.90J45.909, J45.998Pickwickian syndrome278.8E67.8, E67.2, E68Shortness of breath786.05R06.02Unspecified sleep apnea780.57G47.30 (G40 – G47 refer to code section)Insomnia with sleep apnea780.51G47.30 (G40 – G47 refer to code section)Hypersomnia with sleep apnea780.53G47.30(G40 – G47 refer to code section)Body Mass IndexNote: BMI adult codes are for use for persons over 20 years oldBMI codes are used in conjunction with 278.01 (Morbid Obesity) and 278.02 (Overweight) ICD-9 codesBMI less than 19, adultV85.0Z68.1BMI between 19 -24, adultV85.1Z68.20 – Z68.24BMI 25.0 – 25.9, adultV85.21Z68.51BMI 26.0 – 26.9, adultV85.22Z68.26BMI 27.0 – 27.9, adultV85.23Z68.27BMI 28.0 – 28.9, adultV85.24Z68.28BMI 29.0 – 29.9, adultV85.25Z68.29BMI 30.0 – 30.9, adultV85.30Z68.30BMI 31.0 – 31.9, adultV85.31Z68.31BMI 32.0 – 32.9, adultV85.32Z68.32BMI 33.0 – 33.9, adultV85.33Z68.33BMI 34.0 – 34.9, adultV85.34Z68.34BMI 35.0 – 35.9, adultV85.35Z68.35BMI 36.0 – 36.9, adultV85.36Z68.36BMI 37.0 – 37.9, adultV85.37Z68.37BMI 38.0 – 38.9, adultV85.38Z68.38BMI 39.0 – 39.9, adultV85.39Z68.39BMI 40 - 44.9, adultV85.41Z68.41BMI 45.0 – 49.9, adultV85.42Z68.42BMI 50.0 – 59.9, adultV85.43Z68.43BMI 60.0 – 69.9, adultV85.44Z68.44BMI 70 and over, adult V85.45Z68.45Psychological DisordersDepressive disorder - NEC311F32.9 Mental, Behavioral and Neurodevelopmental disorders (F01-F99)Major depressive disorder, single episode, mild296.21 F32.0Depressive disorders296.21 – 296.36F32.0 – F33.42 Bipolar – unspecified296.80F31.9Anxiety state – unspecified300.00F41.9Panic disorder300.01F41.0Stress – unspecified308.9F43.0Adjustment Reaction, unspecified309.9F43.20, F43.9History of abuse, emotionalV15.42Z91.411, Z91.412History of abuse, physicalV15.41Z91.410History of alcohol abuseV11.3Z65.8 Post Operative ICD-9 codes indications for adjustments and other post operative follow-upBariatric surgery statusV45.86Z98.84Belching787.3R14.0, R14.1, R14.2, R14.3Cough786.2R05 (Symptoms and signs involving the circulatory and respiratory systems (R00-R09)Dysphagia, unspecified787.20R13.0, R13.10Dysphagia, oral phase787.21R13.11Dysphagia, oropharyngeal phase787.22R13.12Dysphagia, pharyngeal phase787.23R13.13Dysphagia, pharyngoesophageal phas787.24R13.14Dyspepsia and other specified disorders of function of stomach536.8K30 (Diseases of esophagus, stomach and duodenum (K20-K31)Early Satiety780.94R68.81Esophageal obstruction530.3K22.3Fitting and adjustment of gastric lap bandV53.51Z46.51Gastric outlet obstructions537.0K31.1Gastric ulcer531 (4th & 5th digits required)(Diseases of esophagus, stomach and duodenum (K20-K31)Heartburn787.1R12Inappropriate diet and eating habitsV69.1Z72.4Malabsorption (gastric bypass)579.3K91.2Morbid Obesity – defined as having a BMI of 40 or over; or anyone who is greater than 100 lbs over his or her ideal body weight278.01E66.01 (read guideline)Obesity, unspecified – defined as having a BMI of 30 and above278.00*E66.9, E66.09, E66.1, E66.8Persistent vomiting536.2R11.10Polyphagia (excessive eating)783.6R63.2Post-op surgery syndrome564.2K91.1Reflux esophagitis530.11K21.0Reflux, gastroesophgeal530.81K21.9Regurgitation/Vomiting787.03R11.10, R11.11, R11.12Bariatric Surgery Complications Possible ICD-9-CM CodesAcute Cholecystitis575.10K81.9Acute Cholelithiasis574.20K80.20, K80.80Acute Cholecystitis w Cholelithiasis574.10K80.18, K80.10, K80.12Adhesions – intestinal post-op w obst560.81K56.5Anorexia783.0R63.0Atelectasis518.0J98.11, J98.19Bezoar Obstruction – Food blockage 935.2- E915T18.2XXAInfection due to gastric band px539.01K95.01Other Complication of gastric band px539.09K95.09Infection due to other bariatric px539.81K95.81Other complication of other bariatric px539.89K95.89Diarrhea – following gastrointestinal surgery564.4K91.98Dumping syndrome564.2K91.1Fistula – gastrointestinal537.4K31.6Fistula – post-op persistent 998.6T81.83XAGastric outlet obstruction/stenosis537.0K22.6Gastric Ulcer531.30K25.3Gastrojejunal ulcer534 (4th & 5th digits required)Diseases of esophagus, stomach and duodenum (K20-K31)Marginal ulcer, acute534.00 , 534.01 K28.0Hair loss704.00L65.9, L64.9Hernia – Incisional553.21K43.2Inappropriate diet and eating habitsV69.1Z72.4Lactose intolerance271.3E74.39, E73.0, E73.1, E73.8, E73.9, E74.31Leak – gastrojejunal997.49K91.3, K91.81, K91.82, K91.83, K91.89Malabsorption579.3K91.2Nausea787.02R11.0Phlebitis – unspecified site451.9I80.9Pneumonia – post operative (Aspiration)997.32J95.32Pulmonary Embolism – post operative415.11I26.90, I26.99, T80.0XXA, T81.718A, T81.72XA, T82.817A, T82.818ASmall bowel obstruction560.9K56.56Staple line disruption998.31T81.32XAVitamin deficiencies – multiple 269.2E56.9Vomiting following gastrointestinal surgery 564.3K91.0Wound dehiscence – external998.32T81.31XAWound dehiscence – internal 998.31T81.32XAWound infection – post operative998.59K68.11, T81.4XXABariatric Coding Email Hotline: Please send your questions to the following email: insurance@. ................
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