BCBS, MI question

does anyone know the procedure code for vsg? when i called the insurance company they said there was no code for vsg so i just wondered what everyone else used and if there were any issues with payment after the surgeon billed.

The code is 43659 for sleeve gastrectomy.

When I called BCBS they said it might be covered but your BMI has to be over 50.  It's still considered experimental. Although, you could talk to someone else there and they might say it's covered.


Hope that helps.

43659 (unlisted procedure, stomach) and 43999 (unlisted) and 43843 (Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty) are all used. 

However, there is no specific code for this procedure. 

I do know BCBS consideres this procedure to be experimental and will only approve it in cases of BMI over 50 and approval is not guaranteed.  

Good luck!

thanks im going to call in the morning to see what they say, i really appreciate you all for responding thanks a bunch!!  -Tina

This is what I have been told by BCBS.  

The procedure code you gave us was 43659 with diagnosis code of 278.01.  This code is described as an unlisted gastric procedure .  This service will reject under your coverage and will require a manual review by a medical consultant.  There is no guarantee of payment.


I called them before this and they stated the VSG is suspended for manual review and that the doctor will need to submit the paperwork stating I met the criteria and then they would review for payment.  I guess basically that is the same as the above paragraph.

I plan on having the VSG done because my BMI is 55.  My doctor said it is a two stage surgery being the second part an RNY or DS.  Good news is that many patients have done great with just the VSG and never needed to get the RNY done.  That is my plan at least.  I guess it is how the doctor words everything to the insurance companies and if you meet the criteria you should be set.  Well, at leaste that is what I am hoping for myself.