Question:
I am having insurance insurance due to CPT coding, can anyone help??

I have Guardian insurance with PHCS as the pre-cert. group. I was wondering if anyone had or is having LAP RNY with this insurance. I am having problems with them coding the procedure incorrectly and stating they will only pay $1900. PHCS approved the pre-cert for 3 days in the hospital undergoing LAP RNY. I have been waiting for this insurance company to go to the medical board for review again but I am not sure what I can do if they refuse to pay. My surgery is scheduled for 10/16/02, provided Guardian comes through. I have researched CPT codes and found that the one used by my surgeon is correct (43999) but Guardian doesn't recognize this. I am so worried that they will end up not paying for this procedure. What can I do? Any thoughts or comments are greatly appreciated.    — April F. (posted on September 11, 2002)

September 11, 2002
April,The code my Dr sent to the Insurance was "43846".My Dr is going to do the Laparoscopic RNY. Hope this helps. Nancy Poe
   — NANCY P.

September 11, 2002
I AM NOT HAVING LAP. BUT SOMEOME FROM THIS SIGHT GAVE ME A SAMPLE LETTER OF NESSESSITY THEIR DR. PUT LAPAROSCOPIC CPT CODE 43659???THE EXACT SENTENCE SAYS . THE PLANNED PROCEDURE CPT CODE IS 43846 FOR THE ROUX-EN-Y GASTRCI BYPASS, WITH LAPAROSCOPIC APPROACH CPT CODE 43659. OK DOES THIS MEAN IF I AM HAVING AN OPEN THE CODE IS 43846 AND LAP 43846. MY. DR. ONLY DOES OPEN!
   — CYNDI B.

September 14, 2002
April, I am a coder. The reason why the 43999 code is not being recognized is that is an unclassified code. It is a code used when there is no code for the procedure performed. There is a code for the procedure and I would give it to you, but my cpt book is at work. The code my surgeon used in my predetermination letter was 43843. I am also suposed to have lap rny and I also have PHCS, but through Trustmark. I am waiting on approval myself. Good luck and God bless.
   — ravenprevia

September 14, 2002
My approval letter from my insurance company for an open RNY shows CPT 43846 - "surgery of the digestive system." Before deciding on the RNY, I had previously been approved for a VBG with a different physician, and the same code CPT 43846 was used and approved by my insurance co.
   — lezawomack

Click Here to Return