DS

Looking to get the DS.  Post here for helpful tips on that surgery

wondering if anyone has a link (or pdf file, or article reference) from some sort of organization (such as ASBS, NIH, AMA, etc) that in some way says that BPD-DS is no longer an "experimental" procedure. not looking for a magazine article written by a bari. surg.... but an actual report or article from a medical organization. just to give us "wannabes" some ammo in case our ins co comes back with "no sorry, RNY only.... the DS is experimental" thanks.

I believe Medicare has approved the BPD-DS surgery, the decision has been recorded in the Federal Register. Suzanne Pickens

Yes, I am interested in DS and related surgeries.  I have both United Healthcare Choice Plus and Medicare.  I am having trouble locating a qualified surgeon near me (Palataka, FL).  I would gladly travel to have the surgery, but I understand I will need long term followup care. Suzanne Pickens

in case your insurance company comes back with a denial claiming that the DS is "Experimental" and/or "Investigational" first... go here and print the page for yourself... http://www.ama-assn.org/ama/pub/category/print/3882.html (actually, it's about 9 pages) THEN.... copy and past if you wish, or write your own letter:

            Attached directly to this letter, you will find a copy I have made of a page from the website of the American Medical Association (AMA).  The website, if you wish, can be viewed here…  http://www.ama-assn.org/ama/pub/category/3882.html

            The AMA is the association who came up with the use of the “Current Procedural Terminology” (CPT) codes that are in use today.  The use of CPT codes makes it easier, more efficient (and more error-proof), in communication between doctors, hospitals, insurance companies, etc… it provides a standard nomenclature to document medical services and procedures.  Being an insurance administrator, I am sure you are well aware of WHAT they are and how you need to use them if the process of your daily work.

            Something that you apparently do not know (which you should) is what the CPT codes can tell you about that given procedure.  The attached copy from the AMA website goes into much more detail, but in summary, if a procedure is assigned a FIVE-DIGIT NUMERICAL CPT CODE, then that procedure is a “Category 1” procedure, and NOT considered by the medical community to be “experimental” or “investigational”.  To repeat, the procedure I am seeking is formally known as “Biliopancreatic diversion with duodenal switch” (commonly called “Duodenal switch” or “DS”)

            The CPT code for the Duodenal Switch procedure is 43845 which is found in the AMA’s “CPT Assistant”, volume 15, issue 5, May 2005 and is described as 

            Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)

            The AMA requirements to be assigned a category 1 CPT should, by themselves, be sufficient to prove to you that this procedure should NOT be considered “Investigational” or “Experimental”. I'm hoping this (along with my 200+ page assault) will help ME... might as well help you too if it works.