Bariatric surgery pre-op dx VS. date of surgery vitals

[Michael0630]

Hello,

I have a bariatric surgeon who is using morbid obesity as the primary dx and will send that over for authorization, however, at the time of the procedure the patient does not have a diagnosis of morbid obesity. I queried the provider and I got a response stating they use the dx at the beginning of their program. I am trying to find published guidance on the correct way to code this but I am having trouble. I was under the impression that authorization would need to be updated to reflex the correct dx. In this case the patient had a BMI of 37 at the time of surgery.

Any help is greatly appreciated.

 

[DBrooks912]

I've managed a General and Bariatric Surgery practice for several years, and one thing I've learned is that the morbid obesity diagnosis (E66.01) isn't always accepted as the primary diagnosis. Coverage often depends on the payor's policy. Some insurers may deny claims if this diagnosis is included, especially if their policy states that surgery cannot be performed solely for weight loss purposes. In such cases, I recommend using the appropriate obesity class codes instead. For example, a BMI of 37 would fall under Obesity Class II. If the patient is enrolled in a program, the BMI recorded on their first day can typically be used for authorization purposes.

Hope this helps.