CPT Code(s) for a bariatric revision

[former_vbg 198]

I found out a few days the surgeon I was supposed to be having surgery with next week has been less than honest on submitting for my pre-certification. They didn't even submit for the revision itself, just the sleeve. It's a really long story and still unraveling actually. Aetna has gotten involved and I believe that surgeon's office is now being investigated for violating their contract.

Anyways, I could really use some help with anyone who has access to CPT codes. I am changing surgeons obviously, but now that I am a bit wiser on what to watch on the pre-certification process, I was hoping someone could look up what the code is for a bariatric revision. I don't know if it is broken down based on say a lapband to a sleeve or in my case a vbg to the sleeve. I do know that the revisions are bundled and paid as such, which is one of the reasons this surgeon's office tried to pull a fast one. Never in my life has I experienced such outright deception in something like this. The kicker is, Aetna has them on a recorded line admitting they were doing this- but not realizing it until it was too late. Aetna really stepped up to the plate for me on this one.

So, please anyone that might be able to help me on this- I would really appreciate it. PM me if you prefer.

Thanks.

p.s. I didn't post this in the insurance section because I didn't think it would get as much attention there.

[emilygrace 5]

Is it going to be laparoscopic or open?

43848 Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric band

With all due respect, why are you policing what CPT code they bill? It's obviously in the ins co.'s interests, but how does it affect you financially?

[former_vbg 198]

Is it going to be laparoscopic or open?

43848 Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric band

With all due respect, why are you policing what CPT code they bill? It's obviously in the ins co.'s interests, but how does it affect you financially?

Thanks for the information. The reason is Because I TRUSTED the last surgeon's office to do the right thing by requesting the correct CPT code. I didn't pay attention to the specific language of the approval letter from my insurance because the surgeon's office was satisfied and I just put it in the file. I now find out they only requested just a virgin sleeve and NOT the revision, and then at the 11th hour after I was already scheduled for surgery tried to tell me I needed to come up with additional fees to do the surgery because a revision would take more time. I told them they would need to take that up with Aetna. They couldn't even give me an amount and after two days I called back to get some answers since I was in the process of filing STD at work, re-arranging my entire life at home to be out of the state for a whole week and then they drop that bomb on me. So, after 2 days when they couldn't give me an answer, I asked them how much they have charged past patients and the lady said $2,000. I asked her about the written documentation I had from another individual from their office that I had specifically stating there were NO additional fees besides my co-pays and out of pocket maximums. Then, the next morning when I called to talk to the office manager she went up to $2,500 and refused to honor the written documentation I had from their office saying it was just a mistake. Mind you, this written documentation is from February. This office wasted THREE MONTHS of my time- so it matters to me financially VERY much.

Aetna has since gotten involved because they are in violation of their contract by trying to bill patients for procedures they are supposed to be billing Aetna PER their contract. Back to my original comment- they FAILED to request the CPT code for a revision and thought they could just siphen the extra money from me up front- that I must be some dumb hick and won't know better.

Yes, I'm a bit heated about the whole thing. Anyone in my shoes would be too. Since I have to go through the whole pre-certification process (PER AETNA), I want to be sure this time when I get my pre-certification letter that they have submitted for the correct CPT codes. By them not submitting the correct CPT codes, it made me only eligible for 1 night stay as well- had they submitted for a revision, it would have been I believe at least 2 days, maybe 3- but more than 1.

Make sense? Also, to answer your question, it would be laproscopic.

[emilygrace 5]

Ok, I just asked, no need to jump all over me!

It didn't make sense to me because they get more money reimbursed for the revision, so I didn't see why they wouldn't bill for it. I guess the answer is that they want you to make up the difference.

There is no CPT code for a laparoscopic revision from vbg to vsg.

[former_vbg 198]

Ok, I just asked, no need to jump all over me!

It didn't make sense to me because they get more money reimbursed for the revision, so I didn't see why they wouldn't bill for it. I guess the answer is that they want you to make up the difference.

There is no CPT code for a laparoscopic revision from vbg to vsg.

I'm sorry, I wasn't trying to do that- please accept my apologies. I have wasted 3 months with that office and just very frustrated. As for them getting paid more money for a revision? It is very nominal, probably only $500 to $1,000. They were trying to get me to pay $2,000 and then they went up to $2,500.

[emilygrace 5]

No worries, I know how frustrating it was having to jump through preop hoops, let alone adding in this issue. Hope it gets sorted out for you soon.