Do you accept NYS Medicaid or Managed Medicaid Plan members? Then this blog post is for you!
Non surgical treatment should be attempted: ex. diet and increased exercise.
Bariatric Surgery Adult Patient: 18 years old and over
- BMI index 35 kg/m or greater OR
- BMI index 30-34.9 kg/m and a serious weight-related health problem (ex. High blood pressure, type 2 diabetes or severe sleep apnea)
Pediatric patients: 18 years and older – patients that are deemed physically, mentally, and emotionally mature by a team of various providers ex. Pediatric provider, bariatric surgeon, and or other specialty providers.
- BMI- more and equal to 35 kg/m or more than 120% of 95th percentile of age and sex, whichever is lower AND with a weight-related health problem: ex. diabetes type 2, obstructive apnea – index or Reapiratory Disturbance Index greater than 5, Blount disease, non alcoholic steatohepatitis, slipped capital femoral epiphanies, GERD, hypertension, insulin resistance; or depressed health-related quality of life
- BMI greater than 40 kg/m or greater than 140% of the 95th percentile of age and sex, whichever is lower
Coding:
Most common codes that related to Bariatric Surgery
43644: Laparoscopic Roux-en-Y gastric bypass.
43775: Laparoscopic sleeve gastrectomy.
43770: Laparoscopic placement of an adjustable gastric band
43645: Laparoscopic malabsorptive procedure (e.g., [[Mini-gastric bypass|Mini-gastric bypass]]).
43848: Revision of a gastric restrictive procedure (open).
NYS Medicaid coding and fee resources:
1. Physician Fee schedule- https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fwww.emedny.org%2FProviderManuals%2FPhysician%2FPDFS%2FPhysician_Manual_Fee_Schedule_Sect5.xls&wdOrigin=BROWSELINK
2. Provider Manual- https://www.emedny.org/ProviderManuals/Physician/PDFS/Physician%20Procedure%20Codes%20Sect5.pdf
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