UHC and gastric sleeve

Okay, I still have not figured out how to do even a simple Search on these forums, but going back page by page I've been able to find some GREAT info - thanks, peeps!!

According to the United HealthCare page here:

https://www.unitedhealthcareonline.com/b2c/cmaIndexResult.do ?channelId=016228193392b010VgnVCM100000c520720a____&htmlFile Path=/ccmcontent/ProviderII/UHC/en-US/Assets/ProviderStaticF iles/ProviderStaticFilesHtml/MedicalPolicies/Bariatric_Surge ry.htm

regarding the gastric sleeve:

"The gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch is unproven due to inadequate clinical evidence of safety and/or efficacy in published, peer-reviewed medical literature. "

"Clinical evidence does NOT support the gastric sleeve procedure (also known as laparoscopic vertical gastrectomy or laparoscopic sleeve gastrectomy) when done alone and not a part of the full operation to complete a biliopancreatic diversion with duodenal switch. The available clinical evidence consists of 24 case series, case reports and small reviews. None of the studies reported weight loss at three years or more after the operation, which is considered the most important outcome measure for these studies to report."

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So - next question, has anyone been able to use UHC for a gastric sleeve procedure??  The above is all based on c. 2006 research!!!!    GIMME A BREAK!!!!!

Thanks,

Sheri
 

I have PacifiCare HMO thru UHC and they denied me.

Bummer to hear!  I have UHC and when I called in the CPT code they said they would cover it.  Yesterday my surgeon's office said that the CPT code isn't actually VSG - but the closest thing they have for it, and when UHC reads the description of the actual procedure, they will deny.  Sounds like it is time to start drafting an appeal that includes references >2006 that refutes that position.

In my case I have an add'l reason to appeal - VSG is the most suitable surgery for me since I also have adrenal insufficiency and am thus lifetime dependent on steroids - I take 20mg of hydrocortisone daily.  Along w/NSAIDS, steriods are implicated in ulcer development w/RNY and lapband, and thus are to be avoided.  Let me know if you are going to work on an appeal - maybe we can share drafts and references.

Here are some references to use for an appeal:

The Second International Consensus Summit for Sleeve Gastrectomy, March 19–21, 2009 , 15 June 2009
Abstract: Background: Sleeve gastrectomy (SG) is a rapid and comparatively simple bariatric operation, which thus far shows good resolution of co-morbidities and good weight loss. The potential peri-operative complications must be recognized and treated promptly. Like other bariatric operations, there are variations in technique. Laparoscopic SG was initially performed for high-risk patients to increase the safety of a second operation. However, indications for SG have been increasing. Interaction among those performing this procedure is necessary, and the Second International Consensus Summit for SG (ICSSG) was held to evaluate techniques and results.Methods: A questionnaire was filled out by attendees at the Second ICSSG, held March 19–22, 2009, in Miami Beach, and rapid responses were recorded during the consensus part.Results: Findings are based on 106 questionnaires representing a total of 14,776 SGs. In 86.3%, SG was intended as the sole operation. A total of 81.9% of the surgeons reported no conversions from a laparoscopic to an open SG. Mean ± SD percent excess weight loss was as follows: 1 year, 60.7 ± 15.6; 2 years, 64.7 ± 12.9; 3 years, 61.7 ± 11.4; 4 years 64.6 ± 10.5; >4 years, 48.5 ± 8.7. Bougie size was 35.6F ± 4.9F (median 34.0F, range 16F–60F). The dissection commenced 5.0 ± 1.4 cm (median 5.0 cm, range 1–10 cm) proximal to the pylorus. Staple-line was reinforced by 65.1% of the responders; of these, 50.9% over-sew, 42.1% buttress, and 7% do both. Estimated percent of fundus removed was 95.8 ± 12%; many expressed caution to avoid involving the esophagus. Post-operatively, a high lea****urred in 1.5%, a lower leak in 0.5%, hemorrhage in 1.1%, splenic injury in 0.1%, and later stenosis in 0.9%. Post-operative gastroesophageal reflux (∼3 mo) was reported in 6.5% (range 0–83%). Mortality was 0.2 ± 0.9% (total 30 deaths in 14,776 patients). During the consensus part, the audience responded that there was enough evidence published to support the use of SG as a primary procedure to treat morbid obesity and indicated that it is on par with adjustable gastric banding and Roux-en-Y gastric bypass, with a yes vote at 77%.Conclusion: SG for morbid obesity is very promising as a primary operation.
Michel Gagner, Mervyn Deitel, Traci L. Kalberer, Ann L. Erickson, Ross D. Crosby
Surgery for Obesity and Related Diseases
July 2009 (Vol. 5, Issue 4, Pages 476-485)

Systematic review of sleevegastrectomy as staging and primary bariatric procedure , 11 June 2009
Sleeve gastrectomy (SG) is gaining popularity worldwide as a bariatric procedure both as a first-stage procedure in high-risk or super obese patients and as a primary operation. The potential advantages of the SG are that it confers immediate restriction of caloric intake, does not require placement of a foreign body or require adjustments, and can generally be performed in less time than required for bypass procedures. The possible disadvantages of the SG include the irreversibility, increased operative risk compared with other restrictive procedures, and unproved durability. The purpose of the present systematic review was to evaluate the current evidence regarding weight loss, complication rates, postoperative mortality, and co-morbidity improvement after SG.
Stacy A. Brethauer, Jeffrey P. Hammel, Philip R. Schauer
Surgery for Obesity and Related Diseases
July 2009 (Vol. 5, Issue 4, Pages 469-475)