tci General Surgery Coding Alert - 2017 Issue 6

Reader Question: Focus Documentation for Bariatric Surgery 'Medical Necessity'

Question: We’re getting denials for bariatric surgery even though the surgeon documents the patient’s BMI as showing morbid obesity. What are we missing? Texas Subscriber Answer: You are correct that to show medical necessity for bariatric surgery, you must document morbid obesity. However, many payers also require that you demonstrate a comorbidity to justify the surgery. You should become familiar with each payer’s policy on bariatric surgery to ensure coverage for these procedures. For example, you should list E66.01 (Morbid [severe] obesity due to excess calories) and document the patient’s body mass index (BMI)...

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