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Gastroenterology Coding Alert

Reader Question:

Patient BMI Determines Bariatric Coding

Published on Wed Sep 23, 2009

Question: I heard that Medicare made some changes about diabetic patients' eligibility for bariatric surgery. Do we have to pay more attention to the patient's BMI? Washington, D.C. Subscriber Answer: Medicare did implement some new regulations for bariatric procedures for diabetic patients. The rule: If your physician performs bariatric surgery procedures on a diabetic patient, you need to take note of the patient's body mass index (BMI) -- it could be your magic number in determining the patient's eligibility for Medicare payment, according to MLN Matters article MM6419, effective May 18. Effective for any services performed on Feb. 12 or thereafter, the following three procedures are not covered for patients with type II diabetes (250.x0 or 250.x2) and a BMI under 35 (V85.0-V85.34): • Open and laparoscopic Roux-en-Y gastric bypass (43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Rouxen-Y gastroenterostomy and 43644, Laparoscopy, [...]
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