Wiki weight management

[cpc2013]

This is not my speciality, trying to find out information for internal medicine practice.

Scenerio- group has started up a weight program with a well known weight reduction program controlled diet. (no gastric/banding etc.) The staff in the group had to get certified to do this program and classes, sell products etc.

I was asked if anything can be coded if the physician does a H/P.
lipid panels are run
and patient's are seen for BP/labs/weight and counseling afterwards.
The physicians oversee all of these duties done. The patient then returns for visits periodically for counseling repeat OV, labs, weight etc.

My first thought was preauthorization from insurance plan because many do not pay for dietary programs for weight loss. (these patient's have high BMI and other comorbitities due to weight problem)

Questions: Is this different because it is physician office run program compared to weight watchers, nutrasystem etc?

Can anyone direct me where to begin? or not to even look any further into it?

Thank you-

 

[RNCPC0709]

Most insurance companies will cover......

Most insurance companies I know of (most of the major ones) will cover if certain criteria are met. I definitely recommend requesting a predetermination, as they may have certain criteria that needs to be met (comorbidities, BMI threshold, etc.).

To answer your question more specifically, this is a different scenario than weight watchers, nutrisystems, etc. as it is a physician supervised weight reduction program for a diagnosable condition (morbid obesity).

I would begin by requesting/finding payer criteria on coverage for these services. Try their websites and look for standard coverage policies for weight reduction programs. Most payers now publish these. If you can't find anything call customer service and see if they can help you out.

Good Luck!

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PB