Results 1 to 4 of 4

Workup for Lap Band Surgery

  1. Default Workup for Lap Band Surgery
    New Call-to-action
    When patient was seen for workup for lap band surgery, we used 278.01, V85.41, 327.23, and 401.1 in that order. PA Blue Shield denied the visit because of the diagnoses, I am assuming the primary diagnosis, and says patient is responsible for the visit. My surgeon is not willing to change the order of the diagnoses since obesity is the main reason for the lap band procedure. Has anyone else run into this and, if so, how did you handle it? We are currently in the process of checking with the insurance company to see if they are going to pay the lap band surgery. Our patients are seen in the weight management clinic before scheduled for surgery and the medical diagnosis is used first and then obesity. HELP!!

  2. #2
    Have you sent records proving the patients bmi index?

  3. Default
    We have done that but no reply back yet. Thanks.

  4. #4
    Sioux Falls South Dakota
    The patient's plan could well have an exclusion for the treatment (including surgery) of obesity; even when it's morbid obesity. If it is a plan exclusion, then the patient is indeed responsible for all charges related, included the work up prior to surgery.

    We can't assume that all insurances pay for tx of obesity or that they deny; with most, it is up to the group whether or not they purchase coverage for it.

    I would ask the insurance if it is a contract exclusion, in which case the patient is liable, and I would give them a cost estimate ahead of the surgery.

    Hope this helps,

Similar Threads

  1. Lap band
    By akmorgan in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 02-11-2013, 11:39 AM
  2. lap band
    By RODRIGUEZL in forum General Surgery
    Replies: 2
    Last Post: 04-13-2012, 12:35 PM
  3. Lap Band Surgery and 90 day post-op period?
    By in forum Billing/Reimbursement
    Replies: 2
    Last Post: 02-24-2011, 10:35 AM
  4. Aftercare code following Lap-band surgery
    By nycoder in forum Diagnosis Coding
    Replies: 4
    Last Post: 02-11-2009, 07:46 AM
  5. LAP-BAND Surgery
    By tnapora in forum Outpatient Facilities
    Replies: 0
    Last Post: 06-09-2008, 02:08 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.