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Bariatrics authorization

L

LMCODER1

Networker
Messages
63
It is my understanding that for Bariatric surgery a patient must have a bmi over 35 with a least one co-morbidity or a bmi of over 40 with no additional co-morbidities.
The practice I code for has always submitted co-morbidities with all insurance companies requireing an authorization for the surgery regardless of the patients BMI.
We have a new surgeon to the practice and when I requested that he document the patient co-morbidities he said it wasn't necessary that any pt. with a bmi over 40 didn't need to have co-morbidities for an authorization.
My question is : Are we unnecessarily submitted these co-morbid diagnosis to obtain an auth ?
I would like to know how others are doing it. I am the off-site coderand I do not request auths or do the billing end of it.
If this is soley an individual insurance company requirement I want to be able to tell the Dr. that . He came from another local practice and they never required him to have additional diagnosis which is what makes me wonder if we are doing more then we need to.
Thanks for the input.
 
Bariatrics Authorization

The only time you don't need co-mobid's is when a patient's BMI is 50 & plus. I would ask him to proved the documentation to support his statement.

I don't believe you are doing unnecessary steps noting the co-morbid. Looking at the insurance carrier's policies you must list them. It's one thing to have a high BMI it's another with co-morbid's. This surgery has a limited approval for DX conditions. I wonder if the reason he was with another practice is he didn't like to document all of the conditions the patient had. It's part of the process, not an option.

Gota love those new guys...NOT Hope this helps.
 
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