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The code for the tricare service of the sleeve is Code 43775 43775 Code definition is: LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) Number of pocedures allowed without a overide code is: 1 Tricare Benefits TRICARE covers gastric bypass, gastric stapling and gastroplasty to include vertical banded gastroplasty and laparoscopic adjustable gastric banding (Lap-Band surgery) is covered only when the beneficiary meets one of the following conditions: Is 100 pounds over ideal weight for height and bone structure and has one of these associated conditions: diabetes mellitus, hypertension, cholecystitis, narcolepsy, Pickwickian syndrome, hypothalamic disorders or severe arthritis of the weight-bearing joints Is 200 percent or more over ideal weight for height and bone structure Has had intestinal bypass or other surgery for obesity and because of complications, requires another surgery (takedown) TRICARE does not cover: Nonsurgical treatment of obesity, morbid obesity, dietary control or weight reduction Biliopancreatic bypass, gastric bubble or balloon for the treatment of morbid obesity Note for Active Duty Service Members: Bariatric surgery represents a major and permanent change in your digestive system that requires strict adherence to a specific dietary regimen that may interfere with operational deployment. A history of bariatric surgery is already a bar to military service and receiving bariatric surgery while on active duty may be grounds for separation. For more information, view the Health Affairs Policy 07-006.Should I have surgery to lose weight? Recent research indicates many patients are unable to achieve and maintain large amounts weight loss without the assistance of weight loss surgery. Along with the burden of obesity often times these patients are plagued with diseases associated with excess weight. These diseases are referred to as co-morbidities and include: hypertension diabetes sleep apnea GERD joint pain Co-morbidities may be reduced or eliminated by weight loss. The goal of the bariatric program is to provide assistance to patients who may benefit from significant weight loss and have had little success with more conservative treatment methods. Tricare Prime retirees and dependents who meet specified criteria are eligible for the bariatric surgery program. What surgeries are available? The bariatric procedures currently being performed in the program are laparoscopic gastric banding, laparoscopic sleeve gastrectomy, and open or laparoscopic gastric bypass. All procedures are very effective but differ in surgical technique, dietary modifications, lifestyle changes, medical monitoring, and risk to the patient. Each patient is unique and in consultation with the bariatric surgeon will determine the best surgical procedure. Laparoscopic Gastric Banding is the least invasive but effective weight loss procedure. It is the safest procedure. In this procedure an inflatable silicone band is placed around the upper portion of the stomach. The band is tightened around the stomach by injecting saline into the adjustable band. The tightened band creates a small pouch of the upper stomach which restricts the amount of food the stomach can hold, resulting in weight loss. Laparoscopic Sleeve Gastrectomy is another very effective surgical weight loss procedure in which the stomach is stapled and part of the stomach is removed. The remaining portion of the stomach is called a sleeve. The sleeve remains attached to the small bowel and digestion occurs normally. The small stomach fills quickly allowing the patient a feeling of fullness, reducing the food intake resulting in weight loss. Gastric Bypass is the most invasive and most effective weight loss surgery. In this procedure the stomach size is reduced to a pouch, and the upper portion of the small bowel is bypassed. Weight loss occurs by reducing the amount of food intake into the smaller stomach and by the GI tract's reduced ability to absorb calories and nutrients. Following bypass surgery, the patient will require lifetime medical monitoring for nutritional deficiencies and supplemental Vitamins and minerals. http://www.uptodate.com http://www.webmd.com/diet/weight-loss-surgery/gastric-bypass Do I qualify for the NCA Surgical Weight Loss Program? The eligibility criteria for a consultation with one of our bariatric surgeons are as follows: BMI is a method of classifying body mass into categories used to predict morbidity and mortality. BMI is calculated as follows: weight in kilograms divided by height in meters squared. BMI Criteria: BMI of 35 or greater with co-morbidities BMI of 40 or greater without co-morbidities We currently do not perform surgery on patients with a BMI of 50+ or >400 lbs. Calculate your BMI: http://www.nhlbisupport.com/bmi/ [*]Active duty personnel cannot have weight loss surgery as mandated by BUMED http://www.med.navy.mil/sites/nmcp/Patients/GenSurgery/Documents/ BARIATRIC%20SURGERY%20POLICY_20070326160507_924C6A1B.pdf [*]You must be between the ages of 20-64 years [*]We only accept patients with Tricare Prime [*]Retired military [*]Dependents of military members (Active Duty or Retired) [*]You must not be pregnant or lactating [*]Without multiple serious medical complications related or unrelated to weight How do I begin the process? The road to weight loss surgery begins with an appointment with your Primary Care Manager (PCM). Your PCM is going to play a vital role should you and he/she decide weight loss surgery is the best choice for you, and you should keep in close contact with him/her. If you meet the criteria above and have been unsuccessful with all other methods of weight management, have your PCM enter a consult to the General Surgery Clinic. On that referral, your doctor will need to include the following: your actual weight at the time of the visit, highest weight, height, BMI, and co-morbidities (other conditions caused by obesity). Also, have your PCM put in referrals for evaluations for bariatric surgery: nutrition (Wellness CL BE, 3 visits) exercise physiology (at WRAMC, Wellness CL WR) psychology You will also need orders for the following: blood work: CBC, CMP, Vit D (calcidiol/25-hydroxy) sleep apnea study (guidelines for requirement of test TBD) endoscopy (require EGD for reflux symptoms and require screening colonoscopy for age >50) If you can get all these referrals and orders now, it will help the process go more quickly and smoothly for you. Once the referral is received by the surgery clinic, it will be screened for eligibility requirements and appointment availability. If appointments are not available, the consult will be sent to the Referral Management Department and assistance will be given to locate a Bariatric Surgeon outside the Military Treatment Facility. An overview of our process For more information concerning Tricare Benefits please refer to the website below: http://www.tricare.mil/mybenefit/jsp/Medical/IsItCovered.do?kw=Gastric+ Bypass&topic=Men Exercise Physiology and Physical Therapy (WRAMC) 202-782-1249 Required Consults: Exercise Physiology and Physical Therapy Our Exercise Physiologist and Physical Therapist are members of the multidisciplinary team caring for you in the NCA Bariatric Surgical Weight Loss Program. Through research in their field, their expertise lies in evaluation muscle response to activity and maximizing its positive effect on the body. This information enables them to formulate exercise programs for professional athletes as well as with patients suffering from cardiac conditions, asthma, chronic obstructive pulmonary disease, or bariatric patients with various limitations in their ability to exercise in the normal sense. In collaboration with your surgeon and other team members, they develop a customized exercise program for you. Their program will assist you in developing techniques and movements to improve your mobility and body strength. Exercise, as a requirement of the weight loss program, is a key element in achieving and maintaining long term success in managing a healthy weight. This program will assist you in incorporating exercise into your lifestyle. Services are available at WRAMC. Please call 202-782-1249 for an appointment or more information. Support Group Information NNMC-Bariatric Surgery Support Group Every Wednesday Time: 1530 Location: Conference Room A, Building 7, 4th floor POC: Behavioral Health (301) 295-0500 Stating: Support Group Status: Temporarily on hold until May 2010 or June 2010 WRAMC-Lifestyles & Viewpoints (Behavioral Health group) Wednesdays (except 2nd Wednesday of the month) Time: 6:00pm-7:00pm Location: 5th floor, Ward 53 WRAMC-Monthly Weight Loss Surgery Support Group (Nutrition Care group) 2nd Wednesday of each month Time: 4:30-6:00pm Location: Ward 73 Conference Room (Rm 7347) POC: Beth Triner 202-782-5466 DeWitt Army Hospital 1st Tuesday of each month Time: 4:30pm-5:30pm Location: Main Conference Room To sign up for Support Group please call 703-805-0604 or email Becky.Campbell@us.army.mil The February meeting will take place on Tuesday, February 9th at 4:30 Handouts Nutrition and Exercise Log Websites (PDF) Pre-op eating behaviors (PDF) Nutrition for Bariatric Surgery Presentation( PDF) Bariatric Infomation Session Presentation (PDF) Nutrition Guide-Sleeve Gastrectomy Booklet (PDF) Nutrition Appointment Numbers (PDF) February 2010 Bariatric Support Group flyer (PPT) Forms New pre-surgical assessment (PDF)