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General Surgery Coding Alert

Reader Questions:

Patient BMI Determines Bariatric Coverage

Published on Tue Sep 01, 2009

Question: I heard that Medicare made some changes about diabetic patients' eligibility for bariatric surgery. Do we have to pay more attention to the patient's BMI? Washington, D.C. Subscriber Answer: Medicare did implement some new regulations for bariatric procedures for diabetic patients. The rule: If your physicians perform bariatric surgery procedures on diabetic patients you need to take note of the patient's body mass index (BMI) " it could be your magic number in determining the patient's eligibility for Medicare payment, according to MLN Matters article MM6419, which had an implementation date of May 18. Effective for any services performed on Feb. 12 or thereafter, the following three procedures are not covered for patients with type II diabetes and a BMI under 35: • Open and laparoscopic Roux-en-Y gastric bypass (43846, Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Rouxen-Y gastroenterostomy and [...]
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