Whats the CPT code for VSG....
We all were NEW to this at one time or other! ..no need to apologize AT ALL ,-)
As of Jan 1, 2010...Vertical Sleeve Gastrectomy became OFFICIALLY recognized NO LONGER experimental/investigational...with CPT CODE 43775. The CODE WILL NOT CHANGE
CPT or Current Procedural Terminology is basically a coding system for the pricing of each individual health procedure. It is the American Medical Association that keeps the coding up-to-date and who owns the copy write privileges.
prior to CPT 43775 it was coded to 43659 ..back in the pioneer days ~ 3 yrs ago! lol...when I had VSG...and it WAS investigational/experimental.
*** Insurance Companies STILL TO THIS DAY...will DENY A VSG...on investigational, experimental...EVEN THO IT IS NOT! Typical insurance procedure to be denied at pre-authorization level...for some B.S. reason!
A little on the PROCESS, how I understood it...My blog on VSG INSURANCE WOES:
Currently VSG is considered "investigational" or "experimental" by most insurance companies. NUMEROUS denials are overturned by providing a simple statement to appeal based on these 2 conditions to your insurance company.
VSG will NOT be be removed from experimental/investigational until the AMA gives it an OFFICIAL CPT Code .
Every Jan 1st. AMA provides NIH (see below) with new official CPT codes for medical procedures.VSG is expected formal acceptance in 2010 (see below)
Once NIH accepts VSG as officially accepted it clears the way for VSG to be paid thru Medicare and Medicaid (federal and state medical insurers).
Once federal and state level insured programs accept VSG as formally accepted WLS procedure, ALL insurance companies are MANDATED to follow NIH guidelines and formally accept VSG as an alternative WLS. Currently to be denied on the basis of "investigational" or "experimental" is distressing, but standard insurance protocol.
Currently many insurance companies are unofficially CPT coding VSG to 43659. If you do NOT know what your surgeon's office coded for VSG FIND OUT!! Many times a denial can be due to a wrongly submitted CPT code!!
Per my surgeon more and more insurance companies are approving VSG as it comes out of its "investigational" category. VSG is still relatively new procedure for WL, altho used for other medical conditions in past. First partial-gastrectomy being done like in 1881! VSG as a weight loss surgery has almost 5 year studies breaking through now.
Per protocol 12 US VSG surgeons report their findings on VSG to:
ASMBS ( American Society for Metabolic and Bariatric Surgery).
ASBS (American Society of Bariatric Surgeons) also submit their data on VSG to: ASMBS
ASMBS THEN petitions the AMA for an OFFICIAL CPT CODE. The deadline for CPT petition is in November. In January the AMA releases all new OFFICIALLY ACCEPTED CPT Codes for medical proceedures.
Peace Out Cub Scout!
As of Jan 1, 2010...Vertical Sleeve Gastrectomy became OFFICIALLY recognized NO LONGER experimental/investigational...with CPT CODE 43775. The CODE WILL NOT CHANGE
CPT or Current Procedural Terminology is basically a coding system for the pricing of each individual health procedure. It is the American Medical Association that keeps the coding up-to-date and who owns the copy write privileges.
New CPT Code for 2010
CPT 43775 - Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy)
The Centers for Medicare and Medicaid Services (CMS) and the American Medical Association (AMA) have added a CPT code for Laparoscopic Sleeve Gastrectomy. The code – 43775 Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (ie, sleeve gastrectomy), - was published in the Physician Fee Schedule for 2010 in the Federal Register on October 30, 2009. The code will be effective January 1, 2010 and will make it easier for surgeons to be reimbursed for performing a sleeve gastrectomy where coverage for the procedure has been established or appropriate.
________prior to CPT 43775 it was coded to 43659 ..back in the pioneer days ~ 3 yrs ago! lol...when I had VSG...and it WAS investigational/experimental.
*** Insurance Companies STILL TO THIS DAY...will DENY A VSG...on investigational, experimental...EVEN THO IT IS NOT! Typical insurance procedure to be denied at pre-authorization level...for some B.S. reason!
A little on the PROCESS, how I understood it...My blog on VSG INSURANCE WOES:
Currently VSG is considered "investigational" or "experimental" by most insurance companies. NUMEROUS denials are overturned by providing a simple statement to appeal based on these 2 conditions to your insurance company.
VSG will NOT be be removed from experimental/investigational until the AMA gives it an OFFICIAL CPT Code .
Every Jan 1st. AMA provides NIH (see below) with new official CPT codes for medical procedures.VSG is expected formal acceptance in 2010 (see below)
Once NIH accepts VSG as officially accepted it clears the way for VSG to be paid thru Medicare and Medicaid (federal and state medical insurers).
Once federal and state level insured programs accept VSG as formally accepted WLS procedure, ALL insurance companies are MANDATED to follow NIH guidelines and formally accept VSG as an alternative WLS. Currently to be denied on the basis of "investigational" or "experimental" is distressing, but standard insurance protocol.
Currently many insurance companies are unofficially CPT coding VSG to 43659. If you do NOT know what your surgeon's office coded for VSG FIND OUT!! Many times a denial can be due to a wrongly submitted CPT code!!
Per my surgeon more and more insurance companies are approving VSG as it comes out of its "investigational" category. VSG is still relatively new procedure for WL, altho used for other medical conditions in past. First partial-gastrectomy being done like in 1881! VSG as a weight loss surgery has almost 5 year studies breaking through now.
Per protocol 12 US VSG surgeons report their findings on VSG to:
ASMBS ( American Society for Metabolic and Bariatric Surgery).
ASBS (American Society of Bariatric Surgeons) also submit their data on VSG to: ASMBS
ASMBS THEN petitions the AMA for an OFFICIAL CPT CODE. The deadline for CPT petition is in November. In January the AMA releases all new OFFICIALLY ACCEPTED CPT Codes for medical proceedures.
Peace Out Cub Scout!
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