Overstitch revision after RNY and BCBS Federal

I live an hour from Nashville. My surgeon is in Knoxville which is 160 miles away. I will see him on August 25, to see what needs to be done. I spent a week in the V. A. hospital in Nashville to have an upper and lower GI but even though they admitted me 2 weeks ago, they waited until 11pm Thursday evening to do both procedures the next morning. I hadn't been able to have a bowel movement for 2 weeks. They couldn't get me cleaned out. They tried, miralax, suppositories, clear liquids, keeping me on IV fluids as I just kept throwing everything up. They did the one thing on Sunday afternoon, they gave me a gallon of Col-lite. I was to drink half a gallon with in 1.5 hours, wait 2 hours and finish the rest within 1.5 hours. Sorry Charlie but we can't gulp our drinks down that fast. Plus I can only drink spring water, tap water makes me throw up which I did plenty of that. I had found out I had a rare form of Leukemia 4 months before my gastric bypass, after that I couldn't drink tap water cause of the chemicals and my chemo pills didn't work together, nor could I drink well water anymore. I would throw up flavored waters. So spring water was the only thing I could keep down, I had a gallon of it with me, and they knew I couldn't have tap water, but didn't listen. They GI Dr. discharged me last Tuesday a week ago within 24 hours of being put to sleep to do the procedures. They can't remove the tumor that is in my colon as there is a bleeding ulcer between it and my pouch. Plus the nurses had given me pain medication that Tuesday. There was no way I could drive home at that time. I fell asleep for about 4 hours and the nurses came in and said I had to leave as they needed the room. I don't know how I got home. Everything was a blur and dark outside which didn't help as I can't see to drive after dark. I slept for 2 straight days. But the pouch has to be fixed first, then they will try and remove the tumor to get to the bleed ulcer. So they can't get my bowels cleaned until the pouch is removed from my esophagus to allow fluids to get to my bowels to move. They were afraid of trying to remove the tumor as on the screen the bleeding ulcer is between the tumor and my pouch and afraid of damaging my pouch or my hemoraging. So although I have some blood in my stools, it's not constant as I can't get enough fluids down to get things working. I'm just tired of the pain in my gut, and looking 5 months pregnant with 20 lbs to my stomach. That's the only area I have gained any weight is my belly.

It depends on insurance. Here in Illinois, most of the state insurances cover it, but private ones are wonkier.

Unfortunately, my clinical observation is that the overstitch does one very good thing - make surgeons money.

Sadly, the clients I see who've had it done have never lost drastic weight. I have not yet had one client with decent loss of regain from getting the overstitch, and I've worked with 6-7. While it's a small sample size, I am very dubious about it. Having said that, I've talked with folks in other areas of the country who have been successful too. So, definitely do your research.

For significant weight gain, I would rule out other causes. At first, biological, and then behavioral. Usually for significant weight gain it's almost always based on habit rather than the original surgery.

Usually there are better outcomes revising the RNY itself without the overstitch or getting more malabsorption, especially for a higher BMI. It's not always possible, though, I know. I'm struggling with this now, because while I haven't regained, I will be revising to get malabsorption later this year. It's a difficult decision, that's for sure!

Thank you, I've gained only 20 lbs. but can't stand anything around my waist and it's solid hard. I look like I'm 5 months pregnant. I am seeing my original surgeon on August 25 in Knoxville. But even though I have Medicare Humana insurance, I am a Veteran and they are the ones who are sending out to a bariactric surgeon and prefer that my original surgeon fix the problem. I was in the hospital for a week for an upper and lower GI to see what was going on. There was some irritation in my pouch for the third time in three years running, but it wasn't anything wrong from it. But they put me in the hospital at the Nashville V. A. on a Wednesday, didn't start giving me the miralax until 11pm Thrusday evening to clean me out for a procedure the next morning. They had to wait until Monday as I couldn't have a bowel movement, nor had one for 2 weeks. I just had one yesterday for the first time in a week. My pouch has slipped into the esophagus and there's a bleeding ulcer and a tumor between it and my bowels. They still couldn't get me cleaned out and they tried everything even on clear liquids. They can't get the tumor out until the pouch is put back in place or whatever a revision is. They said that if they had been able to get me fully cleaned out, they would have tried to get the tumor out for biopsy but on the screen it shows the ulcer is bleeding a lot, which makes me weaker. They are afraid they may damage my pouch and if they remove the tumor in my colon below the pouch, I'll hemorage. It's that bad. Even on clear liquids I kept throwing up, I can't get enough fluids in me, and the tumor is in the way so the bowels can't move like they should. But I will see my surgeon, and find out what can be done. Then see if he will work with the Veterans Hospital in Nashville and accept what they will pay to get this resolved. I have to get a pint of blood a week, so this is serious business. I also have leukemia which I found out 4 months before my surgeon in January 2006. I can't drink any water unless it's spring water. They mixed the col-lite with tap water and expected me to drink half a gallon quickly with in 1.5 hours, wait 2 hours and finish the other half in 1.5 hours. There is no way I could drink it that fast, plus I kept throwing it up because of the tap water. So we are concentrating on getting the pouch taken care of first, then wait for that to heal before they try again to remove my guts and take care of the ulcer and tumor.

Thanks for the info.

Oh my gosh, that's awful :( I hope it works for you! Please keep us updated and post ongoing!

I will absolutely keep you in my thoughts

Hi Donna, the only thing that makes me ill is the ability to not being able to eat anything sugar free or with protein. Even chicken broth came right back up. I lived for the most of the time in the hospital on apple juice and jello. Just enough milk to swallow my medications. As for my Leukemia. It's going great, I'm a walking miracle according to my oncologist. I had to have a right hip and femur replaced December 2015 so no bone marrow can get in the right side. This is the first time since I found out I had this 12 years ago, that I have been in complete remission for 14 months. I was having to see her every three months, with blood work done every 6 weeks and iron infusions. Now I see her every 6 months and I know if I need to see her, it's not a problem, as she is fully aware whenever I get blood drawn by any Dr. There's only about 25,000 in the states that has this type of Leukemia, and only about 5,000 get it a year in the world. Because the pills are so expensive, a lot of the insurance companies won't pay for it. So about 5,000 die each year just in the US. I was on the drug that they first came out with in 2000, no problems until I had gastric bypass. My thick hair became super thin and the drug of choice for this Leukemia started depleting my pottasium. The pills I have to take which I can only take one at night and not one in the morning is close to $8,000 a month. Most insurance companies won't even touch this new drug as it's only been out since June 2006, and I went on it that Sept. Medicare had to be notified 2 weeks in advance to approve for a refill. Walgreens and no other drug store carried it as it is so expensive. I get it thru the Veterans hospital. Between Nashville V.A. , Murfreesboro V.A. in Tennessee, and Huntington, West Virginia, I am the only one on this drug. I have hair. It used to grow 3/4" a month, now it takes a year just to grow about 2". I had a lite rinse put on it last September, and it's still in my hair. It's only grown 3" in 11 months and that's with keeping it trimmed which it needs again. The leukemia won't kill me, it's the drivers down here, they just can't drive. Not even on dry roads. They are so in a hurry and going no where. I put my scooter on my lift that is attached to my GMC jimmy with an oxygen tank attached if I'm just going to the store, and they will get right on my bumper. They get hit I get hit, car explode. Veterans affairs would sue them royally as it's their equipment. It's posted on my back window oxygen on board and they can see the tank. but they have to get right up on top of me where I can't even see their headlights. When they do that, I slow down more forcing them to pass me. I don't care. I'm in no hurry to get to where I have to go, to get right on someone's tail. Mom was a school bus driver where we grew up north of Ann Arbor, MI so you know how we learned to drive. Even on a snowy or icy road they don't take procaution. They don't realize that black roads in the winter even the bridges could be blac**** and not just wet. They fly and crash. I have a 4x4 and I stay off the roads. I am not a fool. I will be 64 in September, having been driving since I was 17 and never had a speeding ticket, or an accident that was my fault. How many my age can say that, not even my late parents nor my kids and they are 40 and 38. Well, I will keep y'all informed what I find out when I see my surgeon on the 25th in Knoxville. Stay safe and healthy. Kathy

ICD codes are the diagnosis codes not treatment codes. You want the CPT codes.

I found a 2017 list of bariatric CPT codes which helps, but does not appear to have a code for Overstitch (any form). It can be found at: Metatronic Reimbursment Codes for Bariatric Surgery

To look up ICD (diagnostic) codes I recommend http://www.icd10data.com/

Good luck finding the information you need.

I have fed bcbs and my Overstitch was approved for next week.

I just left the dr'so office and was informedthat I needed this procedure. I too have federal bcbs. Did you have to jump through any hoops for approval?

Do you know the icd 10 codes used that were approved?