Optum360 coding books logo
Optum360Coding.com
    Contact Us   (7 a.m.–7 p.m. CST)
  Home > Coding Central Articles > Coding Central Articles  
Coding Central
Coding Central Home
Inside Track to ICD-10
Coding Central Articles
Code This!
Case Studies
Chargemaster Corner

Articles for:
March 27, 2018


Spring OPPS Update Released

The Centers for Medicare and Medicaid Services (CMS) summarized the spring update to the outpatie... Learn More


Therapy Caps Repealed and Payment for Therapy Assistant Services Lowered

Medicare payment caps on outpatient therapy were permanently repealed effective January 1, 2018. ... Learn More


OIG Update Work Plan, Studies Cardiac Device Credits

In March, the Office of Inspector General (OIG) posted several updates to its existing Work Plan,... Learn More


View Article Archive

Subscribe:
To subscribe, paste this link into your preferred feedreader, or click on one of the buttons below:
 

Medical Coding News Archives

BMI Key to Medicare Coverage of Bariatric Procedures in Diabetic Patients

 
April 28, 2009:

The Centers for Medicare & Medicaid Services (CMS) has just released a national coverage determination (NCD) that states that certain bariatric procedures will be covered when specific criteria are met.

Beginning on or after February 12, 2009, CMS has determined that type 2 diabetes mellitus (T2DM) is a comorbid condition related to obesity and improves the health outcomes when there is a body mass index (BMI) that is greater than 35. 

Bariatric procedures, open and laparoscopic Roux-en-Y gastric bypass (RYGBP), laparoscopic adjustable gastric banding (LAGB), and open and laparoscopic biliopancreatic diversion with duodenal switch (BPD/DS) will be covered services when performed on Medicare patients who meet the requirements listed above. 

However, when performed on patients who do not have T2DM and who have a BMI of less than 35, the services are considered not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act, and therefore they are not covered.

It should be noted that this NCD does not change related NCDs 40.5 (Obesity), 100.8 (Intestinal Bypass Surgery), or 100.11 (Gastric Balloon for Treatment of Obesity). Additionally, providers should be aware that treatments for obesity alone remain noncovered, as does use of the open or laparoscopic sleeve gastrectomy, open adjustable gastric banding, and open and laparoscopic vertical banded gastroplasty procedures, regardless of the patient’s BMI or comorbidity status.

Deborah C. Hall
Clinical/Technical Editor

 

 
Sign in to
Your Account
USERNAME
Forgot your username?
PASSWORD
Forgot your password?
Don't have an account?
It's easy to create one.

Promo code

Have a promotional source code? Enter it here:


What is this?
Shop our catalog
Request or check out the electronic version of our latest catalog.

Medical Coding Books Winter 2018 Catalog