Wiki Diagnosis Coding for Bariatric Surgery

[syrobinson]

The surgeons I work with want to put the co-morbidity first and the diagnosis of morbid obesity and BMI down the list. Everything I have read indicates that as a General Surgeon seeing a patient to evaluate for Lap Sleeve Gastrectomy, the proper way to code is: 1) 278.01 morbid obesity 2) V85.XX BMI 3) Coding of any co-morbidities.
What is happening is the office visits are being denied as no coverage for Obesity Dx and the office is not using the obesity diagnosis to get the surgery pre-authorized and those are being denied as well.
Any help with correct coding on this would be appreciated!

 

[mitchellde]

If the reason for the surgery is morbid obesity then that is the diagnosis that must be used and it needs to be the diagnosis used for the prior auth. However many insurances consider this to be non covered and therefore patient responsibility. You cannot use a diagnosis for payment that is not true for the patient and the visit.