How do you get laparoscopic coverage paid thru Medicare instead of open?

I have Med B. I was told gastric was covered. Apparently my doctor only does laparoscopic (43659) which is an unlisted dump code for MED B. Medicare can't confirm nor deny payment on this code and says that each case is different. If so, what is the basis for their decision. If I need to have open (43846) then my healing time is longer and I am susceptible to infections, and I have a history of poor healing. Just what is it that the doctor office and Medicare want that I can give to them to do it lap. and get it paid? Please email me with any help or advice.

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