Question:
Would sleep apnea be an appropriate primary code?

My insurance, BCBS Fed, will NOT pay for anything with the primary code of morbid obesity. They 100% deny any charge that is coded that way. I am going to go to the surgeons office today and ask them to change the code to one of my co-morbs instead. Have any of you had luck getting approved with a code such as sleep apnea? thanks for the support all, Emily    — Emily H. (posted on October 23, 2003)

October 23, 2003
I've always heard that the Fed plan did cover gastric bypass. I'd do a check on this site to find out who has the same insurance and how their's was submitted. Truthfully I'm sure you would get an insurance to cover WLS based strictly on sleep apnea, but I could be wrong. Are you sure it's not just "obesity" they will not pay on?
   — zoedogcbr

October 23, 2003
Yes, you are correct BCBS Fed does pay for it - BUT NOT if it is coded as morbid obesity. FYI for other bcbs fed emps. Ask your doc BEfore they submit paperwork to not code it as obesity - instead a co-morb.
   — Emily H.

October 23, 2003
I have BC/BS FED and they have paid for all of my pre-op visits including the ones that the doctor's said they wouldn't and made my pay for up front. Is your insurance a PPO or POS? That makes a BIG difference.
   — CAMFR

October 24, 2003
That doesn't sound right, I have heard a lot of folks on this site say that BCBS fed does cover the surgery. I am a coder in a hospital and I do know it would be fraudulent and inapropriate to code sleep apnea as principle diagnosis for a patient coming in for a gastric bypass or other type of bariatric surgery. The principle diagnosis has to match up with the principle procedure. There are a few obesity codes. One is obesity unspecified 278.00, and the other is morbid obesity 278.01. Maybe like Chris D said they won't take the unspecified obesity code.
   — Kara J.

October 25, 2003
I have fed bc/bs. They paid for mine and it was coded as morbid obesity, but included other codes. According to their brochure, they will pay for it if you are over 100 lbs overweight. My doctor said they are one of the easiest insurances to work with. I have had problems with them paying for other things that were coded as morbid obesity like when a blood test was coded incorrectly.
   — Lisa N M.