Diagnositc Code

Does anyone know what the diagnostic billing code for Vertical Sleeve Gastrectomy is? I'm in the middle of open enrollement and  BCBS POS GA has asked me for it.  I called the surgeons office but they seemed to be a little confused. they gave me a cpt code but it was for general bariactric surgery only. thanks.

I'm too new with my Sleeve journey (pre-op) so it may be good to ask this on the VSG Board. They are also the nicest grooup of people, all happy with their Sleeves.

You need to be careful because this procedure is done for different reasons and each has it's own CPT code. 43631 is the partial gastrectomy, but for cancer/ulcers, not WL. The others I've seen (specific for wt loss) are 43659 (laproscopic) and 43843 (open).  I've also seen others that are for more general WLS, and perhaps that is what you were given.  I also heard that there may not be an actual code yet for the Sleeve as a stand alone procedure, and the numbers I gave you above are for the 1st part of the 2-part VSG/DS procedure for higher BMI patients. If you are looking for it as a stand alone procedure, some insurance comp consider it experimental for wt loss as a stand-alone and won't cover it unless you can show why they other procedures aren't appropriate for you. Some folkes had their surgeries denied after the fact because of wrong CPT codes submitted. Funny how the cheaper procedure with the highest safety profile, least complications, side effects, with no follow-up is considered "experimental." With up to 5 yrs history of wt loss that is comprable to RNY and better than the Band, there is a move by surgeons to have the Sleeve the Band and even having it replace the RNY as the gold standard because same wt loss and none of the complications. But it's political, especially with the Band (since the pharm co that designed it is making a fortune and pushed it through ADA approval before we found out all the problems that occur yrs out). Also, check if they cover out of country if you are going to Dr. A.  You may also ask the VSG Board for GA BC/BS sleevers to tell you how things went for them in terms of approval and payment. Good luck, Kahlua  

At this point, there is no real code for VSG.  My doctor uses 43843, but it is more generic, I think it reads something like "partial gastrectomy, not VBG." Insurances may cover the procedure code and still consider VSG experimental and not cover it. I was told it was covered and had to go through 2 appeals. I would try to ask a rep from the insurance company if the specific procedure is covered.  An okay on a procedure code could give you a "false positive" Good luck to you. Martha