Wiki Bariatric Surgeries

Create Wiki Sort by votes
A

Amulligan@lsc-ms.com

New
Messages
2
Best answers
0
I work at a general surgery office and we do sleeves and roux-en-y surgeries. We are trying to follow the CMS guidelines to bill theses surgeries but they keep rejecting on the insurance, stating not approved diagnosis codes and not medically necessary. We were wondering if anyone else is having this issue or have any insight on this issue. We are billing in this order 1. the BMI class code 2. approved CMS diagnosis code 3. BMI code
 
0
I have over 10 years experience in bariatrics. Not all insurances will cover bariatric surgery/morbid obesity. It depends on the individual policy of the patient. Medicare requires E66.01, at least one co morbid condition and BMI of at least 35. Most insurances follow Medicare guidelines but may have other requirements also. You will need to review the policy for each individual patient. I would advise to check the Medicare LCD's for your state. This will give you the specific CPT and diagnosis codes that will support medical necessity. For commercial insurance, I would advise to verify the patient's benefits specifically for bariatrics. Unfortunately, it won't give you the benefits for this online. You will need to call the insurance to verify. Once you have a rep on the phone, provide them with the diagnosis E66.01 and a bariatric code (43644, 43775.....). Hope this helps.



1743956627648.png
 
0
I have a task in front of me to clarify codes used for Bariatric surgery. When billing for 48846, 43770, 43775, and 43644 can you also bill for any of these codes? 43289, 43659, 44238, 47379, 49329, 64488, 43281. Or maybe it just easiest for you to let me know what you bill for these procedures. I have looked up the LCD's but the only code I find is the 64488 that shouldn't be billed with some of those procedures. I am a risk adjustment specialist and have not dealt with much CPT in over oh probable 15 years or so. Can anyone assist me in these procedures and what all to bill for . Thanks a bunch
 
You must log in or register to reply here.
Top