Wiki Bariatric Surgeries and DX

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Peterk50

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Hello

I have a simple 43644 and its rejecting because of the incompatible DX. I've used the E66.01 and a Z code. Any input is helpful!
 
Peterk50 said:
Hello

I have a simple 43644 and its rejecting because of the incompatible DX. I've used the E66.01 and a Z code. Any input is helpful!
Click to expand...

Do they require a co-morbidity as well?

This isn't my area of expertise. However, a quick look on the MCD seems to indicate that at least some MACs require 3 diagnosis codes - the obesity, the BMI, and a co-morbidity.

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Medicare TN - I did do some further research and found I needed to have the obesity ICD10 along with Z code and a co-morbidity code. Thinking that is all I need.
 
Peterk50 said:
Medicare TN - I did do some further research and found I needed to have the obesity ICD10 along with Z code and a co-morbidity code. Thinking that is all I need.
Click to expand...
That is correct.

1. E66.01 (primary)
2. Z code for BMI > 35 (Z68.35 - Z68.45)
3. ICD-10 for co-morbid condition

Medicare tends to be easier to find what you need.

Coverage of bariatric surgery is described in the Internet Only Manual (IOM):
  • Medicare National Coverage Determinations Manual, Publication 100-03, Section 100.1 Bariatric Surgery for Treatment of Co-morbid Conditions Related to Morbid Obesity
  • Medicare Claims Processing Manual, Publication 100-04, Chapter 32, Section 150
100-03

100-04

Also, see:

Claims for any bariatric surgical procedure must include the Primary Obesity Diagnosis Code (Group 1 Codes) and one of the Body Mass Index (BMI) Codes (Group 2 Codes) and a Co-Morbidity Diagnoses Code(s) (Group 3 Codes).
Click to expand...

The list of co-morbidities can altogether be found here and here.
 
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