Wiki medicare and bariatric surgery

[kingkong]

We recently received ASMBS COE and will be able to bill medicare for bariatric surgery, are there any pitfalls or info I should be aware of prior to submitting for payment. Most insurances require prior auth and have a set of criteria, I did find a small bit of info regarding medicare's criteria but sure would like to know ahead if there is something particular to their policy. Thank you in advance.

 

[cmartin]

I'm in Indiana and our Medicare carrier has a Local Coverage Determination in place. They require certain ICD codes and they require them in a particular order. Also, just recently they deemed it necessary for all major bariatric procedures to be in-patient. You'd be smart to go to the CMS site where you can search for both NCDs and LCDs for any location in the one spot, so that you can make sure you have the data you need, and that the rules and conditions that have to be followed and/or met pre-op are all in order.

 

[kingkong]

Thank you