Question:
Does anyone happen to know the Diagnostic and Procedure codes for RNY?

Hi all, I'm considering enrolling in Traditional BC/BS, but in order to find out if WLS is covered I need to get the diagnostic and procudure codes. So if any of you have an insurance statement or something from the hospital with that info on it...I'd greatly appreciate it!!! Thanks!! ~Erin    — Erin D. (posted on December 16, 2002)

December 15, 2002
According to my insurance approval letter the CPT code is 43846.
   — Marcy S.

December 16, 2002
My doctor (Dr. Naaman) has this posted on his website (www.drnaaman.com). I have bcbs ppo of tx. From website: DOES MY INSURANCE COVER THIS PROCEDURE? Most insurances do cover obesity procedures. The first step is to contact your insurance carrier (the phone # is usually on the front of your card) and give them the procedure code # CPT 43846, along with diagnosis which is morbid obesity (ICD-9 #278.01). Be sure to get the first name and last initial of the person you spoke with. They will give you the requirements to meet their "medical necessity". The average insurance company requires documentation of at least two failed medically supervised diets. This includes letters from the supervising physicians and their medical records.
   — Jessie D.

December 16, 2002
My doctor (Dr. Naaman) has this posted on his website (http://www.drnaaman.com/gsbypass.htm). I have bcbs ppo of tx. From website: DOES MY INSURANCE COVER THIS PROCEDURE? Most insurances do cover obesity procedures. The first step is to contact your insurance carrier (the phone # is usually on the front of your card) and give them the procedure code # CPT 43846, along with diagnosis which is morbid obesity (ICD-9 #278.01). Be sure to get the first name and last initial of the person you spoke with. They will give you the requirements to meet their "medical necessity". The average insurance company requires documentation of at least two failed medically supervised diets. This includes letters from the supervising physicians and their medical records.
   — Jessie D.

December 16, 2002
My doctor (Dr. Naaman) has this posted on his website (http://www.drnaaman.com/gsbypass.htm). I have bcbs ppo of tx. From website: DOES MY INSURANCE COVER THIS PROCEDURE? Most insurances do cover obesity procedures. The first step is to contact your insurance carrier (the phone # is usually on the front of your card) and give them the procedure code # CPT 43846, along with diagnosis which is morbid obesity (ICD-9 #278.01). Be sure to get the first name and last initial of the person you spoke with. They will give you the requirements to meet their "medical necessity". The average insurance company requires documentation of at least two failed medically supervised diets. This includes letters from the supervising physicians and their medical records.
   — Jessie D.

December 16, 2002
sorry about all the posts - there was a glitch and then.. viola... three posts (I admit, I probably did them all.) Sorry about that. J
   — Jessie D.

December 16, 2002
I have to add to what Jessie said. Don't take what any insurance company tells you over the phone as fact. My insurance company customer service person said that the surgery was not covered. Granted, WLS is listed in the 'exclusions' part of the policy. But, it is covered if you meet certain conditions. When I was told that it was not covered, I asked to see it in writing. They mailed me a copy of the page where it showed what the criteria were to get the surgery approved. My insurance paid (and paid and paid, see my profile for details).
   — garw