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Not
only did CPT 2005 include two new codes for laparoscopic
gastric restrictive procedures (43644-43645), it also resolved
a problem that had long bedeviled bariatric surgeons.
In the
past, the descriptors for open gastric bypass codes 43842-43848
specified that the "limb" in a roux-en-y procedure
must be 100 cm or less, notes Susan Hvizdash physician education
specialist for the department of surgery at UPMC Presbyterian-Shadyside
in Pittsburgh. Some surgeons like to remove more of the
intestine, resulting in a longer "limb," up to
150 or 160 cm, she explains.
"We
were getting a lot of denials," she recalls, especially
for the laparascopic procedure, for which providers had
to submit documentation. The carriers saw that the limb
was longer than 100 cm and denied the claim because they
deemed a longer limb "experimental."
But
for 2005, the code descriptors for both open and laparoscopic
roux-en-y procedures specify that the limb can be up to
150 cm. This means virtually all of Hvizdash's surgeons'
claims will be covered.
CPT
still doesn't include a code for gastric banding, another
form of gastric restriction surgery, notes Mary Lou Walen,
coding expert at the American Bariatric Surgery Association.
Also, a new device known as a gastric pacemaker, manufactured
by Transneuronix, has shown great promise in treating morbid
obesity, but it still doesn't have a code either, Walen
says.
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