Re: Once and For All, Please Explain Something to me

[Guest guest]

Dee,

The gastric bypass involves stapaling off or transecting the bulk of

the stomach and then bringing part of the small intestine up to the

top of the stomach.

The classic intestinal bypass involved disconecting 90-95% of your

intestine and then connecting the remaining portion to the duodenum

(just below the stomach). The long term side effects of that surgery

were severe.

The duodenal switch is really a biliopancratic diversion with sleave

gastrectomy (i.e. removal of part of the stomach). Biliopancratic

diversion is not really a gastric or intestinal bypass. It is a re-

arangement of the small intestines so that bile and food do not mix

until the end of the small intestine (last 50-125 cm).

There is no CPT code for biliopancreatic diversion or the duodenal

switch. Thus, most surgeons use the code for distal gastric bypass

instead.

Hull

> > > Over 3 weeks ago, Pacificare sent me a letter

> > saying:

> > > Intestinal Bypass Surgery is not a covered

> > benefit " .

> > >

> > > Then it went on to say I could appeal it, etc.

> > >

> > > When their letter was sent to me, my PCP hadn't

> > yet

> > > submitted his Letter of Medical Necessity.

> > Pacificare

> > > was responding to my phone call where I asked for

> > > proof the DS wasn't covered.

> > >

> > > So does that count as a first denial letter? I'm

> > > wondering because if so, I gotta get moving to

> > send in

> > > my appeal.

> > >

> > > Also, does the RNY have an " intestinal bypass "

> > > component? I just don't understand. If so, I was

> > > going to use that on my appeal letter.

> > >

> > > By the way, I called my PCP and he STILL hasn't

> > sent

> > > in the Revised Letter of Medical Necessity! Three

> > > weeks!!!!!!!!!! I gave him the sample letter -

> > all he

> > > has to do is have it copied on his letterhead,

> > sign it

> > > and send it in. Jeez! I told the nurse that I

> > was

> > > running out of time and offered to pick up a blank

> > > letterhead stationary, run home and paste the

> > sample

> > > letter with my fill ins (which I also gave to

> > him!),

> > > print it and run it right back for his signature.

> > She

> > > said he wouldn't allow it. But she's putting the

> > file

> > > on his chair with a note that I have to pick it up

> > > tomorrow.

> > >

> > > , remember when I first posted, saying my

> > doc

> > > was going to sign the letter and I would then have

> > my

> > > surgery? You were so right to slow me down and

> > make

> > > me realize it's not that easy!!!

> > >

> > > Thanks,

> > >

> > >

> > > =====

> > > Dee

> > > Waiting for Ins. Co. Approval

> > > 313/Want to be 165

> > >

> > > __________________________________________________

> > >