Help with CPT codes- getting around ins??

[jennymac 1]

:confused1:I am in the process of getting the sleeve- Just not sure if I will have to self pay or I can get insurance to cover. OK, a little history- had lap band in mex about 3 yrs ago. I had it slip after only a couple of months and had to have surgery. My insurance paid. Later about 1 year later, it eroded and i had to have surgery. HOWEVER, DH and I had just returned from a vacation from Cabo. I was robbed at night the night before we left and thrown down a flight of cement stairs. Just mostly scraped and bruised up. After home that week, started feeling flu like for a couple of days, them BAM, like I hit a brick wall I started going downhill fast. Went to ER, they did all kind of tests and still did not know. BP was tanking fast, white count was through the roof, basically I was in sepsis. Emergency surgery showed a stomach perforation. My stomach had been slowly leaking into abdominal cavity for days until the last day when my liver shifted a bit and allowed the flow to become much more substantial. Anyway, I recovered. Now 100lb back on and more I am getting the sleeve. Insurance paid for this surgery as well, but only because surgery report said that the band was removed as a precaution, that the perforation was due to injury. The surgeon later told me it was a mixed bag b/twn the band and the injury. So I spoke with local surgeon who did the surgery, his billing dept, and spoke hypothetically to my ins co " what if we need to do a revision to my stomach where the perforations was, i.e. weak and portion needed to be removed" they said yeah we will cover it if you need a follow up for the tear. They have an exclusion policy on WLS though, so I have to be VERY careful when submitting the coding. Billing dept asked me what CPT codes should we use? I said I will get back to her. I can't exactly ask my insurance which ones. Its a one shot deal so I need to get it right. Any advice????

Edited May 20, 2010 by jennymac