Help with cpt code 43848 help me understand
Bluecross/Blueshield Policy
C. Repeat of a covered bariatric surgery: Repeat of a covered bariatric surgery may be eligible for coverage only when ALL of the following criteria are met:
- For the original procedure, patient met all the screening criteria, including BMI requirements, AND
- The patient has been compliant with a prescribed nutrition and exercise program following the original surgery, AND
- Significant complications or technical failure (i.e., break down of gastric pouch, slippage, breakage or erosion of gastric band, bowel obstruction etc.) of the bariatric surgery has occurred that requires take down or revision of the original procedure that could only be addressed surgically, AND
- Patient is requesting reinstitution of an acceptable bariatric surgical modality.
I haven't had a revision, but I read a note of someone who did. But the CPT code 43848 is gastric restrictive procedure with gastric bypass for morbid obesity with small intestine reconstruction to limit absorption (including long limbed [>100 cm] gastric bypass and distal bypasses such as biliopancreatic diversion); or revision of gastric restrictive procedure for morbid obesity.
So it sounds like a revision.
And from what you have previously stated, it should not be a problem with getting approved as of the complications and technical failure. Also you got the back up of your trying different programs.
I would also suggest going to the revision forum, there is loads of info there. I hope this helps... Good luck...