You all are so smart help me understand

Orignally I had gastric bypass in 2001.I am having a revision done with my doctor using cpt code 43848 .I have regained about 50 lbs. in the last year.Does anyone know what this coding procedure entails.My doctor said he is going in to repair my original surgery.My pouch and stoma is enlarged. My doctor submitted my paper work on Dec 16,2009 and then Bluecross/Blueshield of Tx. requested a  compliant diet history with a prescribed nutrition and exercise program following the original surgery. My doctor office faxed over my diet history I had with weigh****chers from 5-09 to 11-09 and from the time I had been seeing my doctor ,plus my employer has a health program for us to join on line within our company and that was submitted also I have been complying with for the last 2 years.They also ask that my doctor give details of the procedure for the coding of 43848. On my policy code 43848 is covered. My doctor  faxed over the information originally on Dec 22,2009 but they said they never recieved it but as of  Dec 29,2009 it is now posted in their system.(dr. office had to refaxed information. Since this is all they are requesting  I am hopeful it will be approved.What do you think ? Anyone had this revision before?

Bluecross/Blueshield Policy

C.  Repeat of a covered bariatric surgery:  Repeat of a covered bariatric surgery may be eligible for coverage only when ALL of the following criteria are met:

• For the original procedure, patient met all the screening criteria, including BMI requirements, AND
• The patient has been compliant with a prescribed nutrition and exercise program following the original surgery, AND
• Significant complications or technical failure (i.e., break down of gastric pouch, slippage, breakage or erosion of gastric band, bowel obstruction etc.) of the bariatric surgery has occurred that requires take down or revision of the original procedure that could only be addressed surgically, AND
• Patient is requesting reinstitution of an acceptable bariatric surgical modality.

Best to ask your surgeon to draw you a diagram of what is involved. You shouldnt have to decipher some admin code to be able to understand what is about to be done to you.

Then ask him why he's doing that as opposed to anything else. And what the other options might be.

And lastly ask how many of these he has done, and how many of his patients have gone on to lose more than 90% of their weight.

On the basis that your surgeon is getting paid for this you need some answers before getting on the table.

Hi,

I have a copy of the Empire BC/BS medical policy on baratric surgery and that code states:

43848          Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure).

I am enclosing the link on the policy for you reading pleasure .... hope this helps.

http://www.empireblue.com/medicalpolicies/policies/mp_pw_a053317.htm

best of luck
Scott

PS - RNY can have a failure rate of upto 40%, you may want to check into the DS Surgery
       (http://www.ncbi.nlm.nih.gov/pubmed/19536053)