What CPT code has been apprv'd for VSG?

I have BC/BS and will be submitting for approval. My former insurance denied 43843 and I see on the federal web page they deny 43843, but says they cover gastroplasty. I also see that VSG is sometimes referred to as vertical gastroplasty, so my thought is  to request approval for vertical gastroplasty (I dont see diff between gastroplasty and gastrectomy) but what code is good for that?  Anyone know? I appreciate any info.. Thanks.

My BCBS medical policy says there is no specific code for VSG, most dr's use 43843. I was denied my sleeve through BCBS and sent in an appeal, the appeal was denied, sent in a 2nd level appeal and when we went to the meeting the insurance coordinators kept referring to gastroplasty and the bariatric surgeon on the board asked if they realized the gastroplasty and gastrectomy were 2 different procedures and they stumbled over their words. I really do not think the insurance companies understand and like others say, they are in the money making business not health care so they deny and hope we will go away so they can save money. Appeal the decision. Find out what their reason for denial was specifically and go after that. There is lots of help on these forums.

Thanks for the response/info. What exactly is the difference between gastroplasty and gastrectomy? I went to the webster's dictionary and a medical dictionary and neither addressed gastroplasty. Even here on OH under VSG, it states it is sometimes referred to as a gastroplasty. Just wondering as under BS/BS it states they cover gastroplasty but not investigational surgeries (ie: VSG). Was thinking maybe if Dr. submitted for gastroplasty then maybe it would be approved. I spose the difference is removal of the stomach and stapling of the stomach?? Any why stapling/banding is allowed and removal isn't is beyound me!!!  Anyway, I appreciate your response. I am also thinking since BC/BS covers out of country medical and requires no pre-cert, maybe I will have done in Mexico by Dr. Aceves and then submit under foreign travel (someone else here did that and was reimbursed).   Have you thought of that?  I'll be anxious to hear from you....Hope you had a wonderful Holiday!

Going out country hasn't crossed my mind because you will have to self pay whether you submit to insurance or not and I don't have the funds to self pay so I am completely relying on insurance. Not exactly sure the difference in gastroplasty and gastrectomy other than what you said of the stapling and removing. I know when they first did VSG it was called gastroplasty, which is why I think the insurance companies have such a hard time separating the two. I should hear something today from my insurance as yesterday was day 7 and I was told I would get results within 7 calendar days.

I  don`t  know  if  this  will  help  but  my  doctor  said  they  use  the  code  43659  unlisted   procedure  of  the  stomach. I  have  not  had  my  paper  work  sent  for  approval  yet  but  I  will  let  you  know  good  luck!!!!!!

I have bc/bs ass well and have yet to make any submissions until six month supervised  weight program is completed. However, I did read that your doctor mention using CPT code 43659. After looking up the CPT code under BCBS policy for Surgery for obesity, CPT code 43659 is used for Mini Gastric Bypass.

Again, I dont know much but I think you should appeal as mention by Teresa.