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Hey guys, just want to stop by and give you guys an update, and boy oh boy was I tempted to just let this one go by. Well as you all know I had revision surgery September 30 and was unfilled down to 3cc's at surgery. Now to me 3cc's might as well have been a complete unfill. So here I am 6 weeks later and UP 6 POUNDS!!!!!! Yes, you heard me right and I didnt studder, 6 fricken pounds. Am I surprised? Not really. I'll admit that I got LAZY I enjoyed sleeping in until 6am instead of getting up at 4:30am to go to the gym. My eating post op was going pretty good until my husband (how dare he) took me on an all inclusive 7 day trip to Cabo for my 40th birthday and I Lost my fricken mind. I swear when I got on the plane the scale said 185 (and I know it did because I weighed myself on the scale at the airport where you weigh your luggage). And at the airport on the way home it said 197...I PROMISS IT DID. There was alot of drinking and late night eating on that trip. And honestly I know I didnt gain 12 pounds in 7 days but I knew that I hadnt been eating right and drinking alot of alcohol plus not getting in my water (unless you take in water by sitting in the pool swim up bar?) So 5 days home and the scals was down to 190, 10 days home and there it remained 190 sometimes 191. THANK GOODNESS today was my follow up from surgery appointment where she gave me a fill and I was never so happy in all my life. Theses last 6 weeks have really reafirmed my decision to get the band. with out it I truely have very little will and I really need the restriction that it gives me. I still am a fat girl at heart and in my mind. I still have work to do. C25K here I come and 180 by Christmas!!!!

HEY LADIES!!!! I'm still here. Personally things have been rough, but somehow I make we make it through...one day at a time. My band has probably been my saving grace (weight wise) I am quite sure with out, emotionally eating would have taken control and I would be in a heap of a mess. but as it stands I am doing ok. Still looking for the sweet spot since my revision surgery, the good thing is that since the revision and with all the family drama my weight has only varied 2-4pounds depending on the day and the TOM. I am still working out and trying to do the best I can. I am trying to get these lat 30lbs off by the end of July (i like to set my goal realistic and attainable) so wish me luck. I am going to take it 10 pounds at a time and get this done!!!!! Big Kisses to everyone for all the love and support. It is much appreciated. BTW I posted some pics on my profile. the befores are scarry but the afters...well I like them. TTFN!

Hi my surgery is scheduled for October 4 g-d willing. I am doing it after my holidays just easier to find a place for my 2.5 year old. I had the Lapband almost 6 years ago and lost weight but gained it back and can't seem to loose it. The dr feels I'm a great candidate to the revision and see hopefully no problem with it being the same day. Q to anyone who did it in nyu how much of the shakes am I supposed to drink for the liquid diet???

Anyone else having surgery in April? Maybe we can find surgery twins here. I thought I could start it off by asking a few questions. When is your surgery? April 4th What kind of surgery? Revision from sleeve to Mini Gastric Bypass Height? 5’8” Starting weight? 285 Goal weight? 175

Hey everybody! I'm scheduled for a revision on October 3 with Dr. Chris Sanborn. I initially lost 75 pounds with the band, and started having problems and gained it all back plus some. I'm in my pre-op diet now, and yes I'm starving. lol I think it's interesting that every doctor is different with what they require on their pre-op diets. I'm very excited for my revision that I can hardly contain myself. lol

Good morning! RNY revision 4/3/19 HW 271 SW 260 CW 250 is anyone else having a hard time getting all liquids and calories in? I’ve been so tired. My surgeon told me to eat 800 calories a day and drink at least 64 oz. I’m finding it hard with 30 mins before/after eating. also. When can we have real coffee? 🤣🤣

My big post op report. Today I am 4 days post op revision from VSG to Mini Gastric Bypass. Today I only feel discomfort and no pain at all. In fact, I haven't touched any of the pain medicine I was sent home with. Although, I do have a high tolerance for pain. The biggest issue I had with discomfort was I had a drain paced and it made it nearly impossible for me to get comfortable. I have 3 incisions and one drain "open wound" that should close on it's on. My stomach has bruised pretty bad but all in all it doesn't look so bad. The hardest part of the whole surgery was coming out of anesthesia honestly. I felt perfectly fine after. We even toured Tijuana 2 days post op and were able to walk around the beach and shops with no issues. As far as hunger is concerned...I haven't felt hungry since my surgery at all. It's a very weird thing to me to not feel hungry because before I was always hungry. Well, Head hungry anyway. The thing about being coder after surgery has been absolutely true for me! I have been freezing all day. It's 75 degrees right now (830 pm where I am) and all I want it to bundle up in my husbands thermal PJ's and put a heated blanket on. As they have stated above...BRING CHAPSTICK. That's the only thing I didn't bring that I wish I would have. I have opted to go back to work tomorrow because I have a job where I feel I will have no issues at all. We have filtered water there, a way to heat up broth and I have a mini fridge in my office so thats just about all I need. I do need to remind myself to keep hydrated!

http://mcgs.bcbsfl.com/ Note the timeline on this: 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows: <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested. Gastric surgical procedures for the treatment of clinically severe obesity include: <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band. WHEN SERVICES ARE COVERED: Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language. NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director. Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met: The member: <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months <LI class=bulletedList-1>has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention; does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder). The following procedures may be considered medically necessary when the above criteria has been met: Vertical-Banded Gastroplasty (CPT code 43842) Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. Roux-en-Y Gastric Bypass (CPT code 43644, 43846) Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include iron deficiency anemia, vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach. Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774) Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows: "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives." Biliopancreatic Bypass with Duodenal Switch (43845) The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment). WHEN SERVICES ARE NOT COVERED: Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits. Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity: Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847) Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. This procedure consists of the following components: <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant. Mini-Gastric Bypass (no specific CPT code) Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used. NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass. The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes: <LI class=bulletedList-1>jejunoileal bypass <LI class=bulletedList-1>gastric wrapping Garren-Edwards gastric bubble. BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9 Diagnoses Codes That Support Medical Necessity: 278.01 Morbid obesity REIMBURSEMENT INFORMATION: Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS: Federal Employee Program (FEP): Follow FEP guidelines. State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS: Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum. Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity. Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume. Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion). Gastric bubble: see definition of Garren-Edwards gastric bubble. Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine. Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater. Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES: Gastric Bypass Revision, 02-40000-11 OTHER: Other index terms for gastric surgery: Adjustable gastric banding Bariatric surgery Gastric bypass surgery Lap-Band System Mini gastric bypass Billroth II Long limb gastric bypass Roux-en-Y Scopinaro Vertical banding REFERENCES: <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition) U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01 COMMITTEE APPROVAL: This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION: 10/15/99 Medical Coverage Guideline developed. 09/15/01 Various revisions. 01/01/02 Coding changes. 10/15/02 Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services. 05/15/03 Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria. 09/15/03 Coverage criteria for psychological testing/counseling revised. 10/15/03 Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm. 01/01/04 Annual HCPCS coding update. 04/01/04 2nd Quarter HCPCS coding update; added S2082 and S2083. 07/15/04 Scheduled review; no changes. 01/01/05 HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085. 05/15/05 Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged. 01/01/06 Annual HCPCS coding update (added 43770-43774; deleted S2082). 04/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references. 05/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older. Private Property of Blue Cross and Blue Shield of Florida. This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

Originally Posted by Lap_dancer From BCBS Association (corporate) . 5. The improvement must be attainable outside the investigational settings. The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs. Based on the above, laparoscopic gastric bypass meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. http://www.bcbs.com/betterknowledge/.../20/20_15.html Source found at above website. Yeah, but isn't this just for gastric bypass? I couldn't find anything about gastric banding in this document. JB .................................................................................................. Airman, think of doing searches on this subject like a crossword puzzle. Just because you have a th_ _ K doesn't mean the word is think. You won't find some of the information easily. You should keep track of your searches via your search engine history. Book mark things, reduce the screen and open up another window to continue a new search. Open WORD and copy and paste links and language from documents. ( I do this all the time when I am researching). I'm not an insurance agent but here is what I have learned about Blue Cross and Blue Shield. Blue Cross and Blue Shield (BCBS) is like a mall. Inside the mall you have different stores that you can shop from. So you get Blue Cross, Blue Shield, Blue, Blue Options, ... Google is a good friend. Please utilize this in your efforts to gain information available to you. Google entry from me was: BCBS South Carolina weight loss surgery HITS: Suburban Surgical Care Specialists, S.C. - Bariatric Surgery Vanderbilt Center for Surgical Weight Loss, Exclusion List The Next Step for Weight-Loss Surgery Blue Distinction Centers for Bariatric Surgery That one sounds good, I think I'll try it......... (thinking, if BCBS doesn't cover it and thinks Lap Band is experimental, I won't find a hit on my search ) Inside this HIT I see it is the BCBS site, I'l go to SEARCH and type in GASTRIC HIT: Displaying results 1 - 5 of 5 items found. 1. TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity (Web Page; Thu Jan 25 15:43:00 EST 2007) EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures,... Description: Laparoscopic Adjustable Gastric Banding for Morbid Obesity 2. Laparoscopic Gastric Bypass Surgery for Morbid Obesity (Web Page; Mon Oct 30 15:26:00 EST 2006) Assessment ProgramVolume 20, No. 15 February 2006Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net... Description: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. 3. Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass (Web Page; Mon Oct 30 15:27:00 EST 2006) Assessment ProgramVolume 20, No. 5 August 2005Executive Summary Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities.... Description: Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities. HIT: TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass is the most common procedure performed in the U.S., and offers the most favorable benefit/risk ratio among established procedures. Laparoscopic adjustable gastric banding (LAGB) is an alternative technique that has the potential advantages of being less invasive and reversible. Prior TEC Assessments have concluded that LAGB does not meet the TEC criteria. Objective: To review the available evidence on whether LAGB results in similar improvements in health outcomes as does open or laparoscopic gastric bypass (GBY). Search strategy: MEDLINE search for the period of 1980 through September 2006, supplemented by hand search of bibliographies and search of Cochrane database. This goes on but it tells me that they are NOT calling it "investigational." PRINT AND SAVE 1. The technology must have final approval from the appropriate governmental regulatory bodies. Bariatric surgery itself is a procedure and is not subject to U.S. food and Drug Administration (FDA) regulations. However, certain devices that may be used as part of the procedure may be subject to FDA approval. The Lap-Band® system received premarket application (PMA) approval by the FDA in June 2001 for use in morbidly obese patients. 2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes. The evidence is sufficient to permit conclusions concerning the short-term safety and efficacy of LAGB in comparison with GBY. Weight loss at 1 year following LAGB is substantial, in the range of 40% EWL, although less than that seen following GBY. The short-term complications of LAGB are very low, with serious short-term complications being uncommon, and mortality exceedingly rare. Rates of short-term adverse events, including serious procedural complications and mortality, are lower for LAGB compared with GBY. Same page, further on down the page. Airwayman, I could truthfully sit here for the next span of time and do this research for you but in the end, it teaches you nothing on perserverance. I am a teacher. I teach my students that perserverance pays off. In the frustration of learning, there is victory in the end. *I began my own Quest knowing NOTHING about the surgery, my own insurance plan nor how the process works. After six months, I can answer pretty much any question thrown my way. Tomorrow I will get my chance to educate the insurance committee at work. They were told "gastric surgery is not covered by Blue Cross", I beg to differ. http://mcgs.bcbsfl.com/ Search: Medical Coverage Guidelines BCBS HIT: 1.(61.06% Relevant)Gastric Electrical Stimulation... peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling 64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver 0155T Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature ...2.(59.05% Relevant)Gastric Bypass Revision... gastrectomy or intestine resection; with vagotomy 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only 43887 Gastric restrictive procedure, open; removal of subcutaneous port component only 43888 Gastric restrictive procedure, open; removal and replacement of ...>>3.(58.83% Relevant)Surgery for Clinically Severe Obesity... or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the ... 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION. Non-Covered Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines Other References Updates DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows:

I wish I was so lucky, this is my post above and after 3 days of the slip I had to have emergency surgery and have my band revised, 3 hr surgery, lots of scar tissue around the band, I could not eat or drink anything lost 15 lbs in a week. I am 4 weeks post op, just got a 2 cc fill and gained the 15 lbs back:scared2:..anyway they used the same band and just hiked it up and sewed it back in place, he called it an acute prolapse and said it was due to the weight loss and the band got loose and slipped, he said it was a pretty severe prolapse. good luck, sounds like u will be fine.....:thumbup:

Oregondaisy just had a facelift in Mexicali...I was being revised w/Dr Aceves while she was there..she liked her surgeon..just a thought

I've been at goal for a year now and am ready for a breast implant revision (had the same ones for 31 yrs now). I'm going for a consult in June with a local doc, but was wondering if anyone has had plastics done in Mexico. If so, by whom, what did you have done, what was the cost, and were you concerned at all about your safety? Any other information would be appreciated. Thanks for your help!

Hi When did you have surgery? I was Dec 11th and feel like I'm losing very slowly, to be expected after band revision...

Wow! One month of liquid diet?! You can do it!!! Are you able to incorporate greek yogurt during this time? It was a life-saver for me during my liquid diet prior to my gastric sleeve surgery. I’m scheduled for a revision to RNY on August 8th so I start my liquid diet on Monday July 25th. I see my nutritionist at the bariatric center this morning to go over dietary requirements for RNY. I’m not nervous about the surgery since I’ve already had one bariatric procedure and did just fine. I just remember struggling some during the liquid diet. It can be tough but will be sooo worth it! 😁👍🏻

My first 50 lbs lost someone said "Pam did you drop a couple of pounds?) .grrrrrrr. well I probably did wear my pants a bit on the comfy side before but sheesh, 50lbs? Funny thing is 15 lbs more and then people were more like omg. Pammmmmmm you lost so much weight. I think your body hits a place where it changes. Then Id lose another 30 and no one would notice then 5 lbs more then it would be omg your gonna be skinny soon. Now after 100 lbs every 10-15 lbs is kinda noticable and my clothes changes. In fact I had a revision in early October and ive gained 35 lbs back and none of my clothes fit. sad!!!

Hi Kelly and kpardisek. I was scared also so that's why I did lapband. Was going to do the sleeve for the revision but the dietician I was working with talked to me about gbp. Boy am I glad we talked, best decision.

Hi my name is Kim. Had revision surgery band to gastric on August 16, 2013. Feeling GREAT!

I'm not sure of a lot of statistics with revision but I do recall some info about the 5 day pouch test which is supposed to help get you back on track. Good luck!

Wow, does she know the carbonation in soda stretches the pouch. I hag RUN back in 2001, I had sutures left inside and developed a hiatal hernia so they did revision and I'm 3 weeks out and having lots of left side pain still and tired of liquids. But I stopped soda back in 2001

I am 4 days out (surgery was wednesday) from having my revision from lap band to bypass. I had this all planned out in my mind as going perfectly. Im one to bounce back fast and this has been anything but. To be honest, im pretty scared and emotional. The surgery itself i've been told went pretty well. There was a lot of scarring inside from the band. He left a drainage tube in place which I know is pretty routine. I wasn't getting much comfort from pain medication at all. My oxygen levels kept going down which im sure was due to the pain. The doctor sent me home Friday towards evening with oxygen and pain meds. Through the evening and into the night it just got worse and worse. Around 930am I finally couldn't take it anymore.I was shaking crying and hurting so badly. He had me come back to the hospital. He thought maybe I had gotten dehydrated. Im sure that is possible. How are you supposed to keep up on the Fluid intake while you are resting? Finally around 6pm the Dr gets back to my room and decides he is going to take out the drainage tube. That was a large relief from pain. My oxygen stats increased, but im still in a decent bit of pain. So now I am the evening of the 4th day. I've taken meds to keep me from getting sick twice. I made sure to get my Vitamins in. Im trying hard to get the 2oz of liquids every 30 minutes in but im struggling. And the pain just wont subside much. Im a complete emotional mess. Im worried about having panic attacks and making things worse. I did this to improve my health and right now I feel like i've made the biggest mistake of my life. I know I can't be the only one feeling like this. I want to know there is light at the end of this tunnel. Any suggestions you can give to help the pain, get my fluids down, not become an emotional mess, anything really. I would appreciate it.

It is different because of the types of surgery and because I am getting mine done at Mayo most of it comes from research. I know I almost cried reading that "soft food stage/phase 3" is 6 weeks! I am getting a revision done..maybe longer recovery?

I had the band done 5 years ago and lost 80 lbs. In the beginning I always wanted for him to add fills and he wouldn't till I mastered it.I admire this. He takes the time to see you. I have been having problems the last year and I am getting the revision surgery to the sleeve on June 16.I found out he trained some other top band sleeve surgeons.

I'm sorry you've had such bad GERD. I suffer from it too now which is why I told my surgeon that I wanted the bypass instead of the sleeve. This forum is where I found out about the prevalence of GERD worsening after sleeve. Good luck with your revision!

I had severe acid reflux prior to surgery, so I had gastric bypass because sleeve will only make the condition worse. Many on this site had sleeve only to have it revised to gastric bypass because of problems with GERD after they were sleeved.

ebonie...that is exactly what I was looking for...thanks! I am starting to get freaked out about my decision (and I am not even approved yet) I think I need to stop getting online and reading all these people post about lap band revisions, etc Oh, and I have a whole page of questions for Dr. T :smile2: