Wiki Bariatric Lap Sleeves and Medicare

[bdorin]

I'm new to bariatric coding and have a client who was getting paid on 43775 from Medicare first part of last year by coding Morbid Obesity, one co-morbidity and BMI > 35. All the claims I've submitted since that time with the same type of dx's are being denied by Medicare for dx's not covered. I'm stumped as to what to do next. Did something change after April 2016? They've not had a good biller since May of last year and I'm doing the clean up. I'm filing electronically...do I need to drop to paper and send the op note?

Thanks for any help!!

 

[cgaston]

I am not sure what state you are in but here's the LCD from NGS Medicare:

https://www.ngsmedicare.com/ngs/por.../?clearcookie=&savecookie=&REGION=&LOB=Part B

It shows that the diagnoses should go 1) morbid obesity 2) BMI 3) comorbidities

 

[bdorin]

I am not sure what state you are in but here's the LCD from NGS Medicare:

https://www.ngsmedicare.com/ngs/por.../?clearcookie=&savecookie=&REGION=&LOB=Part B

It shows that the diagnoses should go 1) morbid obesity 2) BMI 3) comorbidities

Maryland - so I could not look that up

 

[lindsey.hansen]

Did you find your LCD? It will tell you what the payable dx's are. And read the fine print it will tell you exactly in what order to code.
Lindsey