Is a revision of an old rny considered a fix on a pre-existing condition?

randy S.
on 4/28/11 1:48 am - brooklyn, NY
Is a revision  of an old rny considered a fix on a pre-existing condition?
Is there a cpt code for a revision for a gastric bypass that is not considered bariatric surgery?  Since a revision is a fix on a pre existing condition. Or am I just grabbing at straws???? 
TRISLOU
on 4/28/11 3:58 am - glendale, NY
 I just had my revision done yesterday. I had a Stomaphyx  done. I feel real good. They did not even have to cut me. I was trying to do this for some time. My old insurance co did not want to cover it. 
reillye
on 4/29/11 1:02 am
Hi Randy,
I wondered the same thing as my new insurance excluded all bariatric procedures, and I was having issues with my band.  In the end, my answer was to go on another insurance plan that did cover bariatrics (for significantly more $ every month).  But while I was researching options, I basically found that if there is a medical problem that needs fixing, like say a band that is slipped, they will fix it because it is a medical problem, not a bariatric problem.  The moment it becomes bariatric (for me that meant converting to another surgery) they would not cover it.  I imagine insurance companies handle it pretty much the same way.  If you have an exclusion for bariatrics, it's all about whether your doctor's office can convince your insurance company that whatever you need is medically necessary for reasons other than weight loss. 

Insurances not covering pre-existing conditions has to do with having a lapse in coverage.  From the tone of your mail this is not your problem -- but I could be wrong.

Good luck -
Eileen
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