Wiki Bariatric controversy

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AHudyma

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We have a bariatric patient who does not have a bariatric rider on his plan. A thought in the office was to bill the removal of the lap band to insurance 43774 (we rec'd auth) and then to self pay for the bariatric surgery (43644) The CPC's in the office do not think that this is correct. We feel that the removal of the lap band should be billed and that's it, or to have the surgery completely self pay and bill nothing to the insurance company.

Another thought was to do two separate op notes, one for the removal and then another for the gastric bypass, but the CPC's feel that those code are inclusive to one another and that the 43848 should be billed only (if done lap).


Please advise…Any thoughts would be appreciated.
 
I find it rather strange that with no bariatric benefits that they will cover removal of the band but not pay for a roux-en-y. Do they have a limitation of one bariatric procedure? I think we would make sure that they cover removal, have patient sign a waiver and then do a cash pay for the non-covered procedure. What insurance is this? I know they are getting more and more picky about what they will and will not cover.
 
lindacoder said:
I find it rather strange that with no bariatric benefits that they will cover removal of the band but not pay for a roux-en-y. Do they have a limitation of one bariatric procedure? I think we would make sure that they cover removal, have patient sign a waiver and then do a cash pay for the non-covered procedure. What insurance is this? I know they are getting more and more picky about what they will and will not cover.
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If the band is being moved for a medical reason, the band has slipped, it's causing erosion many times it can be removed and covered.
 
right so even though the 2 codes are usually bundled suggestions on how to bill since partial surgery was auth'ed.
just 43774 to ins
just 43644 to pt
or bill one to pt one to ins-which is what doesnt seem right??
thank you
 
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