GOBO, DAWN & STEVE/Unique Code for DS?

[Guest guest]

I posted something along this line a week or two ago, but got no

response. Gobo, this may not help your case right now, but I think

it would go a long way to helping the BPD/DS become more accepted as

a 'gold standard'. The problem is that there is NOT a specific code

for the BPD/DS (the sleeve gastrectomy component with retention of

the pyloric valve and section of the duodenum).

This is actually part of the problem in my situation. My insurance

is telling me I cannot go out-of-network to have this surgery because

there are in-plan surgeons who can provide it. They see it as " all

gastric bypasses are created equally " because there is no unique CPT

code for the BilioPancreatic Diversion with Duodenal Switch.

So here is my question to the list... How does a new CPT code get

created and accepted by the insurance industry. Does there have to

be an act of Congress? FDA approval? AMA endorsement? Surely all

these studies about the long-term success rates of the DS and the

highly reputed opinions of the ASBS must be worth SOMETHING to this

end? It seems to me that there currently exist unique codes for less

well-proven or successful procedures. How did they get there?

Terri Hassiak

BMI

60http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

5/19/01 surgery date CANCELLED due to " Out-of-Network " Ins. Denial

email(no spaces): bunsofluff @ hotmail.com

> > Yes, the BPd/DS is the same. Dr. Hess's letter to my

> insurance company

> > called my surgery a long limb roux en y (which it is--in addition

> to other

> > things). He then went on to list codes (but didn't name what

> they are) that

> > included the reduction of the stomach and other intestinal

> parts. I had no

> > problem getting approved (which I am thankful for every day).

> When my letter

> > of approval from the insurance company came it said " gastric

> bypass is a

> > covered benefit under this patient's plan. " Never did Dr. Hess

> or the

> > insurance company use the terms duodenal switch. I think

> this is partly

> > because there are no official " codes " for the DS. Doctors have

> to use other

> > codes which they feel best represent it. I was in no way going

> to call the

> > insurance company and start throwing the DS terminology

> around. By the way

> > Dr. Hess's office was amazed at how well my insurance paid

> on the surgeons'

> > fees.

> >

> > Dawn

> > Dr. Hess, Bowling Green, OH

> > BPD/DS

> > www.duodenalswitch.com

> > 267 to 165

> > size 22 to size 10

> > have made size goal, weight goal may need to be adjusted.

> > no more high blood pressure, sore feet, or dieting!