tci General Surgery Coding Alert - 2016 Issue 4

You Be the Coder: ICD-10 Must Tell Full Story for Bariatric Surgery

Question: When I’m billing for bariatric surgeries, I’m having problems with denials that seem to indicate a lack of medical necessity. The surgeon always documents morbid obesity, and I always code it. What could be the problem? SuperCoder Subscriber Answer: You are correct that morbid obesity is often the first diagnosis required to demonstrate medical necessity for bariatric surgery. But ICD-10 coding guidelines require you to report additional codes to further define the condition. And many payers also require evidence of co-morbid conditions that demonstrate specific ill-health effects of the obesity. Perhaps your claims are falling down...

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