Question:
How do you get laparoscopic coverage paid thru Medicare instead of open?

I have Med B. I was told gastric was covered. Apparently my doctor only does laparoscopic (43659) which is an unlisted dump code for MED B. Medicare can't confirm nor deny payment on this code and says that each case is different. If so, what is the basis for their decision. If I need to have open (43846) then my healing time is longer and I am susceptible to infections, and I have a history of poor healing. Just what is it that the doctor office and Medicare want that I can give to them to do it lap. and get it paid? Please email me with any help or advice.    — Bonnie G. (posted on January 21, 2003)

January 21, 2003
Medicare doesn't do pre-approvals. I have medicare and they paid for mine. Mine was open rny so I could get the ring around the stoma. They will pay for lap also. They are mainly going to decide if they pay or not based on diet history, co-morbiditys, and if it is medically ness. If you have any questions just email me at: [email protected] . Hope this helps.
   — Angie L.

January 21, 2003
I also have medicare and had no problems having lap RNY. I went in asking for open because I thought with my weight ( over 350 pounds ) I wasn't a good canidate for lap but my doctor is a specialist and has preformed lap rny on patients over 600 pounds. It was him who made the decision to do Lap Rny and medicare paid for everything. What the previous poster says is correct they wont pre approve or prepay they have to be billed after the surgery. Best of luck to you ... Brie
   — Subrina D.

January 22, 2003
Bonnie - Medicare pays for surgeries on a review type system. Since the CPT code used is an Unlisted Procedure code your surgeon (who's billing office should know) should submit a copy of consult visit & a copy of the OP note from the surgery. I work in the billing office of a surgeon that does the LAP procedure, every once in a while we'll get one that is a hard case to get paid but mostly Medicare pays for the surgery. I hope this helps.
   — Kevin D.

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