Still rolling and storing data and sites:
http://mcgs.bcbsfl.com/ Medical guidelines ( criteria to meet) for BCBS
Medical codes and diagnostic codes
Subject: Gastric Bypass Revision
http://mcgs.bcbsfl.com/index.cfm?fus...ision#P24_1042 DESCRIPTION:
In cases where a severe, potentially life threatening condition develops which is documented in the medical record, gastric bypass revision is considered medically necessary and may be eligible for coverage.
WHEN SERVICES ARE COVERED:
The following lists examples of conditions
AND/OR diagnoses for which gastric bypass revisions may be covered:
- <LI class=bulletedList-1>Weight loss of 20% or more below the ideal body weight (based on the 1996 Metropolitan Life Height & Weight tables Men and Women) <LI class=bulletedList-1>Esophagitis (e.g., esophageal reflux) <LI class=bulletedList-1>Hemorrhage or hematoma complicating a procedure <LI class=bulletedList-1>Vomiting (bilious) following gastrointestinal surgery <LI class=bulletedList-1>Gastrointestinal complications, (i.e., complications of intestinal (internal) anastomosis and bypass) <LI class=bulletedList-1>Stomal dilatation, documented by endoscopy (not UGI) <LI class=bulletedList-1>Pouch dilation documented by upper gastrointestinal examination or endoscopy, producing weight gain of 20% or more <LI class=bulletedList-1>Stomal stenosis after vertical banding, documented by endoscopy, producing vomiting or weight loss of 20% or more <LI class=bulletedList-1>Other and unspecified post surgical nonabsorption (i.e., hypoglycemia and malnutrition following gastrointestinal surgery) <LI class=bulletedList-1>Other post-operative functional disorders (i.e., diarrhea following gastrointestinal surgery), <LI class=bulletedList-1>Severe dumping syndrome <LI class=bulletedList-1>Post-gastric surgery syndromes (i.e., post-gastrectomy syndrome, post-vagotomy syndrome) <LI class=bulletedList-1>Disruption of operation wound <LI class=bulletedList-1>Staple line failure, documented by upper gastrointestinal examination
- Disrupted staple line provided there has been prior weight loss.
WHEN SERVICES ARE NOT COVERED:
Gastric bypass revision services are not covered when coverage criteria are not met as described in the
WHEN SERVICES ARE COVERED section or when the member's contract does not provide benefits for these services.
BILLING/CODING INFORMATION: http://mcgs.bcbsfl.com/index.cfm?fus...ision#P24_1042
CENTERS for bariatrics BCBS To Your Health Distinction Centers
http://www.fepblue.org/toyourhealth/...centindex.html
HIPAA regulations from BCBS
http://www.fepblue.org/privacyhipaa/hipaareg_mov.html
Federal Employee Program BCBS
http://fep.careenhance.com/portal/index.jsp 