New 2010 CPT code for Laparoscopic Sleeve Gastrectomy
ASMBS Insurance Committee Updates
Jaime Ponce MD, FASMBS
Chair, Insurance Committee
New 2010 CPT code for Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy has a new CPT code effective January 1, 2010:
43775 -- Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy)
The relative value of this CPT code is set by CMS and it will be 21.56 (work RVU) which is between the laparoscopic adjustable gastric banding and the gastric bypass roux-en-y relative value.
Medicare will not be covering this procedure at this time.
Bariatric Coding Email Hotline
The ASMBS Insurance Committee in response to multiple requests from our members and their office staff have decided to offer an “Email Hotline" for bariatric coding questions. We have accumulated previously asked questions and will be able to adapt answers according to your specific case in question.
In within the Committee members, there is significant expertise and will do our best to answer your coding question.
Please send your questions to the following email: [email protected]
SOURCE: http://www.asmbs.org/Newsite07/EmailArticles/ASMBSInsuranceC ommitteeUpdates.pdf
Jaime Ponce MD, FASMBS
Chair, Insurance Committee
New 2010 CPT code for Laparoscopic Sleeve Gastrectomy
Laparoscopic Sleeve Gastrectomy has a new CPT code effective January 1, 2010:
43775 -- Laparoscopy, surgical, gastric restrictive procedure; longitudinal gastrectomy (i.e., sleeve gastrectomy)
The relative value of this CPT code is set by CMS and it will be 21.56 (work RVU) which is between the laparoscopic adjustable gastric banding and the gastric bypass roux-en-y relative value.
Medicare will not be covering this procedure at this time.
Bariatric Coding Email Hotline
The ASMBS Insurance Committee in response to multiple requests from our members and their office staff have decided to offer an “Email Hotline" for bariatric coding questions. We have accumulated previously asked questions and will be able to adapt answers according to your specific case in question.
In within the Committee members, there is significant expertise and will do our best to answer your coding question.
Please send your questions to the following email: [email protected]
SOURCE: http://www.asmbs.org/Newsite07/EmailArticles/ASMBSInsuranceC ommitteeUpdates.pdf
You see things; and you say 'Why?'
But I dream things that never were; and I say 'Why not?'
- George Bernard Shaw
When I saw your post I called my insurance company and they now have this CPT code in their system as an approved surgery!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 
So I now need to get another letter from my PCP and call my surgeon once it gets done so they can re-submit my paperwork. Man, I'm gonna have my fingers and toes crossed! I KNOW this will be the year of my VSG, I just know I'll be a skinny ***** this year!
(deactivated member)
on 1/6/10 9:05 pm - Woodbridge, VA
on 1/6/10 9:05 pm - Woodbridge, VA
"Medicare will not be covering this procedure at this time."
That's not good news. I know a lot of people had been saying Medicare would be covering the VSG as soon as there was a code, starting 1/1/10.
That's not good news. I know a lot of people had been saying Medicare would be covering the VSG as soon as there was a code, starting 1/1/10.
Anthem is also dubbing the new CPT "investigational" - http://www.anthem.com/medicalpolicies/policies/mp_pw_a053317 .htm
However, they also state that:
Sleeve Gastrectomy
This alternative surgical approach to gastrectomy involves resection of the greater curvature of the stomach resulting in a stomach remnant shaped like a tube or "sleeve." It can be performed by open or laparoscopic technique and can be done as a stand-alone procedure or as the first in a two-stage procedure subsequently followed by a malabsorptive procedure, such as biliopancreatic diversion with duodenal switch. It has been proposed by some surgeons for very high risk patients where weight loss following sleeve gastrectomy may improve a patient's overall medical status and reduce risk for subsequent more extensive malabsorptive procedures.
Perhaps anyone appealing an Anthem denial can use this "bolded" language & any credible studies on safety to overturn the denial (?)
However, they also state that:
Sleeve Gastrectomy
This alternative surgical approach to gastrectomy involves resection of the greater curvature of the stomach resulting in a stomach remnant shaped like a tube or "sleeve." It can be performed by open or laparoscopic technique and can be done as a stand-alone procedure or as the first in a two-stage procedure subsequently followed by a malabsorptive procedure, such as biliopancreatic diversion with duodenal switch. It has been proposed by some surgeons for very high risk patients where weight loss following sleeve gastrectomy may improve a patient's overall medical status and reduce risk for subsequent more extensive malabsorptive procedures.
Perhaps anyone appealing an Anthem denial can use this "bolded" language & any credible studies on safety to overturn the denial (?)
Jill, thanks for the info. Not surprisingly, it looks like Medicaid/Public Aid is following accordingly...
Utah Medicaid lists it as "uncovered"
http://health.utah.gov/medicaid/manuals/pdfs/Medicaid%20Information%20Bulletins/Traditional%20Medicaid%20Program/2010/January2010-MIB.pdf
NC Medicaid listed as "pending further research"
http://www.ncdhhs.gov/dma/bulletin/0110bulletin.htm#cpt
Utah Medicaid lists it as "uncovered"
http://health.utah.gov/medicaid/manuals/pdfs/Medicaid%20Information%20Bulletins/Traditional%20Medicaid%20Program/2010/January2010-MIB.pdf
NC Medicaid listed as "pending further research"
http://www.ncdhhs.gov/dma/bulletin/0110bulletin.htm#cpt
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