Wiki Bariatric Coding Question

[tcranston]

We have billed 43644 for the gastric bypass, however our physician also went in a did a laparoscopic procedure on the liver and the only code that works is the unlisted code 47379. Insurance company is denying the code saying it is "incidental" to the gastric bypass. Any suggestions on if this is correct or if there is a better code to use. I have not been doing bariatric surgery coding for very long. Thank you!

 

[michellepilcher]

For most insurance, the biopsy is incidental. Most Blue Cross plans will pay for it if the patient had clinical signs prior to surgery (labs, ultrasound, etc). Aetna is hard to convince unless the biopsy shows a serious pathology dx; they do pay if that turns out to be the case. The CPT is correct, but you'll have to convince most payers that you have the correct code. Our Medicaid has paid half of them; I appealed but getting them paid is completely hit or miss.