Subject: CPT codse (was Re: stupid insurance companies)

[Guest guest]

Hi.

Now you've given me something new to worry about. Jusk kidding. I

hope.

Anyway, when I called my insurance company to see if the surgery

would be covered, I was told by the surgeon's office to check CPT

code 43846 even though I wanted the DS. I was told by my insurance

then that 43846 is covered. I had understood at that time (back in

August) that there was no separate CPT code for the DS, that all

gastric surgeries were under the same CPT code. Has that changed?

Also, I remember sometime in the past that someone posted a way their

doctor had phrased the description of the DS procedure to make it

stand out less when passing through the insurance company review

process. Is it what Carole posted that Dr. Hess called it or

something else? Can anyone help me find that? I've looked and

looked, but had no luck.

I'm already gearing up for a fight with the insurance company, and

since my surgeon is so pro-RNY, I don't expect much help from that

quarter. But if I can get them to use wording for the DS on the LOMN

that will get it past the reviewer at the insurance company, I may be

ahead of the game.

Thanks!

who is now on three BP meds and not so much trying to cheat the

insurance company as save my life...

Pre-op Consult: Dec 6

Dr. Scholten

Grand Rapids, MI

> In a message dated 12/1/01 6:57:28 PM Eastern Standard Time,

> duodenalswitch@y... writes:

>

> << I have understood from previous posts that sometimes RNY is used

to refer

> to

> the bypass part of the surgery and not the " stomach " part. >>

>

> As long as they approved CPT code 43847 as the primary procedure

> >(sometimes 43633 secondarily), I don't think that you need to go

any

> >further with this.

>

> Dr. Hess uses both of the above, I got the 43847 approved, which is

gastric

> bypass. Dr. Hess calls it " long limb reu en y, because when they

were

> showing me a drawing of the procedure it is like a Y (one side

enzymes, the

> other side food without enzymes) and the bottom of the Y is the

common

> channel.

> so if you got the 43847 approved, I agree with , you don't

need to go

> any further with this. Anyway, this is a gastric bypass, as

doesn't gastric

> mean (food) and it is being bypassed, right?

> I actually think we are lucky there is no specific code for DS,

because if

> there were......

> Carole