Do you know if BCBS Federal covers DS?

I had the VSG done in 2009.  Apparently, I did not reach my goal. 

In case I decide to get a revision from VSG to DS.  Would that be considered a revision or 2nd part of DS?     

Does BCBS Federal cover it?  The doctor's office gave the cpt code of 43659 for DS. 

Thanks so much for replying.

As far as I have read, Federal BCBS would cover the DS.  As for them considering it a separate surgery or a revision (I think that they would consider it a separate surgery because your intestines have NEVER been touched, right??!!  So, I do not think that revision would play into this at all.

Try Wikipedia for the codes:
http://en.wikipedia.org/wiki/List_of_ICD-9_codes


Here is the DS:
http://en.wikipedia.org/wiki/Duodenal_switch

Duodenal switch ICD-9-CM

Intervention

43.89, 45.51 45.91[1]

The first number is for the stomach portion, but the other 2 numbers pertain to the intestines.
-Jamie

 

Hi smileyjamie72,


You are so right.  When I had my LB removed and the VSG done in 2009 .  They only covered the removal of the band. 

So, it would be the Duodenal switch only that would need to be covered.  The VSG part that only involved my stomach was paid out of my pocket in 2009.  I guess I will find out when my doctor's office calls it in for me. 


Thanks so much......

Hi, I just found your post regarding VSG to DS & whether BCBS federal would cover it.  I'm in the same exact situation & was wondering what happened with you since it was several years ago?  Any advice would be great.  Thanks.