difference between cpt code 43843 and 43775?
Hi,
So I just got off the phone with my insurance (blue shield of ca), they told me that cpt code 43775 was covered. They described is a lap gastric sleeve. I called my surgeon and told them (they had previously told me that it was not covered) and they were very suprised they asked me what code i told them, and i told them 43775. She told me that the insurance lady has been doing this a long time and she uses code 43843 and blue shield denies it. Does anyone know the difference or could someone shed some light on this?
So I just got off the phone with my insurance (blue shield of ca), they told me that cpt code 43775 was covered. They described is a lap gastric sleeve. I called my surgeon and told them (they had previously told me that it was not covered) and they were very suprised they asked me what code i told them, and i told them 43775. She told me that the insurance lady has been doing this a long time and she uses code 43843 and blue shield denies it. Does anyone know the difference or could someone shed some light on this?
I can only give you the descriptions of them - they sound like the same thing, but the 43843 is more ambiguous....here they are.
43843 - Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty
43775 - Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)
Sounds like your surgeon's office may not have known about the updated code, causing them to code the more ambiguous one. My guess is that when they redid the codes in 2009 they added the latter one, as the sleeve is more frequently performed and it deserved its own code.
Hope this helps! =)
<3
43843 - Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty
43775 - Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)
Sounds like your surgeon's office may not have known about the updated code, causing them to code the more ambiguous one. My guess is that when they redid the codes in 2009 they added the latter one, as the sleeve is more frequently performed and it deserved its own code.
Hope this helps! =)
<3
Laurie =)
my blog: www.laurot95.blogspot.com
HW - 361/SW - 338/GW - ONEderland somewhere......
(loss reflects 23# loss pre-op)
my blog: www.laurot95.blogspot.com
HW - 361/SW - 338/GW - ONEderland somewhere......
(loss reflects 23# loss pre-op)
As a previous employee of Blue Cross who will be returning in 6/2010. I have some info for you
The new cpt code is now 43775 laparoscopy, surgical gastric procedure, longitudinal gastrectomy(sleeve) 90 day global procedure.
open gastric restrictive procedure without gastric bypass for mrbid obesity other than vertical banded gastric procedure they will use 43843.
The reason is your are not having open bypass pass, this is a laproscopic procedure which is covered and 43775is a new code for the new 2010.
They may need to get specific info from insurer to cover proceudre. Good Luck
The new cpt code is now 43775 laparoscopy, surgical gastric procedure, longitudinal gastrectomy(sleeve) 90 day global procedure.
open gastric restrictive procedure without gastric bypass for mrbid obesity other than vertical banded gastric procedure they will use 43843.
The reason is your are not having open bypass pass, this is a laproscopic procedure which is covered and 43775is a new code for the new 2010.
They may need to get specific info from insurer to cover proceudre. Good Luck
Nicole Schen-Whit 
How could you have such a good life like me if there wasn't a God directing?
How could you have such a good life like me if there wasn't a God directing?
Michele220 -
I replied to this so it would pop back up at the top of tonight's list... hoping it will catch your attention if you are still on... read the above threads... perhaps relates to your denial... worth looking into...
-Sniffles.
Height 5'9" Highest BMI - 45.3 Current BMI - 24.2
03/27/10 - 307 (pre-surgery), 03/30/10 - 303 (surgery), Now - 164
Most Active
Recent Topics
