Question:
I think I will get approved. What's you're Opinion

Orignally I had gastric bypass in 2001.I am having a revision done with my doctor using cpt code 43848 .I have regained about 50 lbs. in the last year.Does anyone know what this coding procedure entails.My doctor said he is going in to repair my original surgery.My pouch and stoma is enlarged. My doctor submitted my paper work on Dec 16,2009 and then Bluecross/Blueshield of Tx. requested a compliant diet history with a prescribed nutrition and exercise program following the original surgery. My doctor office faxed over my diet history I had with weigh****chers from 5-09 to 11-09 and from the time I had been seeing my doctor ,plus my employer has a health program for us to join on line within our company and that was submitted also I have been complying with for the last 2 years.They also ask that my doctor give details of the procedure for the coding of 43848. On my policy code 43848 is covered. My doctor faxed over the information originally on Dec 22,2009 but they said they never recieved it but as of Dec 29,2009 it is now posted in their system.(dr. office had to refaxed information. Since this is all they are requesting I am hopeful it will be approved.What do you think ? Anyone had this revision before? Bluecross/Blueshield Policy C. Repeat of a covered bariatric surgery: Repeat of a covered bariatric surgery may be eligible for coverage only when ALL of the following criteria are met: For the original procedure, patient met all the screening criteria, including BMI requirements, AND The patient has been compliant with a prescribed nutrition and exercise program following the original surgery, AND Significant complications or technical failure (i.e., break down of gastric pouch, slippage, breakage or erosion of gastric band, bowel obstruction etc.) of the bariatric surgery has occurred that requires take down or revision of the original procedure that could only be addressed surgically, AND Patient is requesting reinstitution of an acceptable bariatric surgical modality.    — BlessedHighlyFavored (posted on January 4, 2010)

January 5, 2010

   — eyeflirt4fun