LCD/NCD Portal

L29317

 

SURGICAL MANAGEMENT OF MORBID OBESITY

 

 

01/29/2013

 

Indications and Limitations of Coverage and/or Medical Necessity

 

CMS National Coverage Policy:

 

• CMS national policy dictates that surgery for morbid obesity is covered for Medicare beneficiaries who have all of the following:

o A body mass index of 35 or higher.

o At least one comorbidity related to obesity.

o Have been previously unsuccessful with medical treatment for obesity.

• Bariatric surgical procedures are covered only when performed at facilities that are:

o Certified by the American College of Surgeons as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006).

o Certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (program standards and requirements in effect on February 15, 2006). Approved facilities and their approval dates are listed and maintained on the CMS coverage Web site:

 http://www.cms.gov/MedicareApprovedFacilitie/BSF/list.asp

• Surgical procedures for morbid obesity that are covered under national policy for qualifying Medicare beneficiaries include:

o Open and laparoscopic Roux-en-Y Gastric Bypass (RYGBP). (CPT code 43644 & 43846).

o Open and laparoscopic Biliopancreatic Diversion With Duodenal Switch (BPD/DS) (CPT code 43845).

o Laparoscopic Adjustable Gastric Banding (LAGB).(CPT 43770).

• Surgical procedures for morbid obesity that are not covered under national policy for all Medicare beneficiaries include:

o Open adjustable gastric banding. (CPT code 43843& 43999).

o Open sleeve gastrectomy. (CPT code 43843& 43999).

o Open and laparoscopic vertical-banded gastroplasty (CPT code 43842& 43999).

o Gastric balloon.(CPT code 43999).

o Intestinal Bypass(CPT code 44799).

• Note: Any service associated with the above noncovered services are also noncovered.

 

 

Local Coverage Determination:

• Gastrointestinal surgery for obesity, also called bariatric surgery, promotes weight loss by closing off parts of the stomach to make it smaller.

o Program payment may not be made for treatment of obesity alone since this treatment cannot be considered reasonable and necessary for the diagnosis or treatment of an illness or injury.

• Bariatric surgery procedures must be performed by a surgeon trained and substantially experienced with surgery of the digestive tract, working in a clinical setting with adequate support for all aspects of management, assessment and follow-up.

o The American College of Surgeons (ACS) and American Society for Bariatric Surgery (ASBS) certification requirements for physician and institutional credentialing satisfy this requirement.

o Physicians and institutions who do not meet ACS or ASBS certification criteria for performing bariatric procedures do not qualify for Medicare payment for bariatric surgery procedures.

• Laparoscopic sleeve gastrectomy (LSG)* - CPT code 43775

• Change Request 8028, Transmittal 2590, dated November 9, 2012 (Implementation date December 10, 2012) for the CMS Manual System, Pub. 100-04, Medicare Claims Processing Manual, Chapter 32, Section 150.5 & 150.6 revisions, effective for claims for dates of service on or after June 27, 2012.

• Medicare Administrative Contractors acting within their respective jurisdictions may determine coverage of stand-alone laparoscopic sleeve gastrectomy (LSG) for the treatment of co-morbid conditions related to obesity in Medicare beneficiaries.

• The surgical management for the treatment of morbid obesity [is considered] reasonable and necessary for all NCD covered bariatric surgical procedures and Laparoscopic sleeve gastrectomy (CPT code 43775) when ALL of the following conditions are met and recorded in the medical record:

o The patient meets the definition of morbid obesity which is defined as a body mass index (BMI) > 35 and comorbid conditions exist (e.g. hypertensive cardiovascular disease, pulmonary/respiratory disease, diabetes, sleep apnea or degenerative arthritis of weight-bearing joints). Documentation of the level of severity of the comorbid existing condition must be included in the patient’s medical record.

AND

o The patient has been previously unsuccessful with medical treatment for obesity.

AND

o Treatable metabolic causes for obesity (e.g., adrenal or thyroid disorders) have been ruled out or have been clinically treated if present.

o AND

o When performed at facilities that are:

 certified by the American College of Surgeons as a Level I Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006).

Or

 Certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (program standards and requirements in effect on February 15, 2006).

 A list of approved facilities and their approval dates will be listed and maintained on the CMS coverage website @ http://www.cms.gov/MedicareApprovedFacilitie/BSF/list.asp, and published in the Federal Register.

 

Unsuccessful Medical Treatment for Obesity

• With or without bariatric surgery, successful obesity management requires adoption and lifelong practice of healthy eating and physical exercise (i.e. lifestyle modification) by the obese patient.

o Without adequate patient motivation and/or skills needed to make such lifestyle modifications, the benefit of bariatric surgical procedures is severely jeopardized and not medically reasonable or necessary.

o Patients considering bariatric surgical options must have been provided with knowledge and tools needed to achieve such lifelong lifestyle changes and must be capable and willing to undergo the changes.

• For the purposes of this LCD, a patient will be deemed to have been unsuccessful with medical treatment of obesity if all of the following minimal requirements are met per documentation in the medical record:

o The patient has BMI ≥ 35 at the time of surgery.

o The patient has been provided with knowledge and tools needed to achieve such lifelong lifestyle changes, exhibits understanding of the needed changes and has demonstrated to clinicians involved in his or her care to be capable and willing to undergo the changes.

o The patient has made a diligent effort to achieve healthy body weight with such efforts described in the medical record and certified by the operating surgeon.

o The patient has failed to maintain a healthy weight despite adequate participation in a structured dietary program overseen by one of the following:

 Physician (MD or DO).

 Registered dietician (RD).

 Board certified specialist in pediatric nutrition (CSP).

 Board certified specialist in renal nutrition (CSR).

 Fellow of the American Dietetic Association (FADA).

Preoperative Psychological/Psychiatric Evaluation

• Patients who have a history of psychiatric or psychological disorder or are currently under the care of a psychologist/psychiatrist, or are on psychotropic medications, must undergo preoperative psychological evaluation and clearance and the patient’s record must include documentation of the evaluation and assessment.

• An objective examination by a mental health professional (psychiatrist or psychologist) experienced in the evaluation and management of bariatric surgery candidates to exclude patients who are unable to personally provide informed consent, who are unable to comply with a reasonable pre- and postoperative regimen, or who have a significant risk of postoperative decompensation is recommended.

o Such evaluation is a Medicare-covered service.

o A diagnostic session is appropriate, and treatment sessions are appropriate if the patient has a diagnosable disorder that is likely to adversely impact the surgical outcome including post –operative compliance.

o The mental health professional, the surgeon and the patient should be in agreement that the patient is an appropriate candidate for the surgery.

 

Comorbid Conditions

• Severe obesity (BMI) ≥ 35 kg/m2 is known to exacerbate numerous medical conditions. Comorbid conditions for which bariatric surgery is covered include the following:

o Type II diabetes mellitus (by American Diabetes Association diagnostic criteria).

o Refractory hypertension (defined as blood pressure of 140 mmHg systolic and/or 90 mmHg diastolic despite medical treatment with maximal doses of three antihypertensive medications).

o Refractory hyperlipidemia (acceptable levels of lipids unachievable with diet and maximum doses of lipid lowering medications).

o Obesity-induced cardiomyopathy.

o Clinically significant obstructive sleep apnea.

o Obesity-related hypoventilation.

o Pseudotumor cerebri (documented idiopathic intracerebral hypertension).

o Severe arthropathy of spine and/or weight-bearing joints (when obesity prohibits appropriate surgical management of joint dysfunction treatable but for the obesity).

o Hepatic steatosis without evidence of active inflammation.

• Consideration of the risk-benefit for each individual patient must be used to determine that surgery for obesity is the best option for treatment for that patient and no contraindications to bariatric surgery may exist.

 

Contraindications to Bariatric Surgery

• Any major procedure has significant benefit and risk (injury or death) that the treating physician discusses with the patient.

• To meet Medicare’s reasonable and necessary (R&N) threshold for covered surgeries in the treatment of morbid obesity, the physician’s documentation for the case should clearly support the indication and the medical need (the procedure does not exceed the medical need and is at least as beneficial as existing alternatives & performed at facilities that are certified by the American College of Surgeons as a Level I Bariatric Surgery Center.

• The following list includes contraindications to surgery to treat morbid obesity and lacking compelling arguments for an exception in the supporting documentation, the hospital (FISS claim) and physician services (MCS claim) can be denied if reviewed.

o Prohibitive perioperative risk of cardiac complications due to cardiac ischemia or myocardial dysfunction.

o Severe chronic obstructive airway disease or respiratory dysfunction.

o Non-compliance with medical treatment of obesity or treatment of other chronic medical conditions.

o History of significant eating disorders, including anorexia nervosa, bulimia and pica (sand, clay or other abnormal substance).

o Severe hiatal hernia/gastroesophageal reflux (for purely restrictive procedures such as LAGB).

o Autoimmune and rheumatological disorders (including inflammatory bowel diseases and vasculitides) that will be exacerbated by the presence of intra-abdominal foreign bodies (for LAGB procedure).

o Hepatic disease with inflammation, portal hypertension or ascites.

o Failure to cease tobacco use at least 6 weeks prior to surgery.

o Psychological/psychiatric conditions:

• Schizophrenia, borderline personality disorder, suicidal ideation, severe or recurrent depression, or bipolar affective disorders with difficult-to-control manifestations (e.g., history of recurrent lapses in control or recurrent failure to comply with management regimen).

• Mental retardation that prevents personally provided informed consent or the ability to understand and comply with a reasonable pre- and postoperative regimen.

• Any other psychological/psychiatric disorder that, in the opinion of a psychologist/psychiatrist, imparts a significant risk of psychological/psychiatric decompensation or interference with the long-term postoperative management.

• Note: A history of or presence of mild, uncomplicated and adequately treated depression due to obesity is not normally considered a contraindication to obesity surgery.

 

Limitations of Coverage:

• Under provisions of this LCD, the following procedures are not considered reasonable and necessary and will be denied:

o Mini-gastric bypass (CPT code 43999).

o Long limb gastric bypass (i.e. more than 150 cm) (CPT code 43999).

o Silastic ring vertical gastric bypass (Fobi pouch) (CPT code 43999).

• Procedure codes 43886, 43887and 43888 are for open port replacement. The open port replacement procedures are non-covered since they are associated with the non-covered open gastric restrictive procedures. For covered laparoscopic restrictive procedures that require port replacements use 43771, 43772, or 43773.

• 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only.

• 43887 removal of subcutaneous port component only.

• 43888 removal and replacement of subcutaneous port component only.

 

 

CPT/HCPCS Codes

 

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

43770 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; PLACEMENT OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE (EG, GASTRIC BAND AND SUBCUTANEOUS PORT COMPONENTS)

43771 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REVISION OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE COMPONENT ONLY

43772 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE COMPONENT ONLY

43773 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL AND REPLACEMENT OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE COMPONENT ONLY

43774 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE AND SUBCUTANEOUS PORT COMPONENTS

43775 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY)

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

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

43847 GASTRIC RESTRICTIVE PROCEDURE, WITH GASTRIC BYPASS FOR MORBID OBESITY; WITH SMALL INTESTINE RECONSTRUCTION TO LIMIT ABSORPTION

43848 REVISION, OPEN, OF GASTRIC RESTRICTIVE PROCEDURE FOR MORBID OBESITY, OTHER THAN ADJUSTABLE GASTRIC RESTRICTIVE DEVICE (SEPARATE PROCEDURE)

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 SUBCUTANEOUS PORT COMPONENT ONLY

43999 UNLISTED PROCEDURE, STOMACH

 

 

ICD-9 Codes that Support Medical Necessity

 

For procedure codes 43644, 43645, 43770, 43775, 43845 43846, and 43847.

 

Report the primary diagnosis as 278.01, then an additional secondary diagnosis for the body mass index (BMI) and a third diagnosis for the comorbidities as appropriate. Coverage for selected bariatric surgery procedures on patients who meet national and local coverage criteria set forth in this LCD requires reporting three appropriate diagnoses.

 

278.01 MORBID OBESITY

V85.35* BODY MASS INDEX 35.0-35.9, ADULT

V85.36* BODY MASS INDEX 36.0-36.9, ADULT

V85.37* BODY MASS INDEX 37.0-37.9, ADULT

V85.38* BODY MASS INDEX 38.0-38.9, ADULT

V85.39* BODY MASS INDEX 39.0-39.9, ADULT

V85.41 BODY MASS INDEX 40.0-44.9, ADULT

V85.42 BODY MASS INDEX 45.0-49.9, ADULT

V85.43 BODY MASS INDEX 50.0-59.9, ADULT

V85.44 BODY MASS INDEX 60.0-69.9, ADULT

V85.45* BODY MASS INDEX 70 AND OVER, ADULT

 

Additional diagnosis for comorbidity to be reported in addition to the primary diagnosis of 278.01 and the secondary diagnosis for the BMI.

250.00 DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.02 DIABETES MELLITUS WITHOUT MENTION OF COMPLICATION, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.10 DIABETES WITH KETOACIDOSIS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.12 DIABETES WITH KETOACIDOSIS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.20 DIABETES WITH HYPEROSMOLARITY, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.22 DIABETES WITH HYPEROSMOLARITY, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.30 DIABETES WITH OTHER COMA, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.32 DIABETES WITH OTHER COMA, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.40 DIABETES WITH RENAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.42 DIABETES WITH RENAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.50 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.52 DIABETES WITH OPHTHALMIC MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.60 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.62 DIABETES WITH NEUROLOGICAL MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.70 DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.72 DIABETES WITH PERIPHERAL CIRCULATORY DISORDERS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.80 DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.82 DIABETES WITH OTHER SPECIFIED MANIFESTATIONS, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

250.90 DIABETES WITH UNSPECIFIED COMPLICATION, TYPE II OR UNSPECIFIED TYPE, NOT STATED AS UNCONTROLLED

250.92 DIABETES WITH UNSPECIFIED COMPLICATION, TYPE II OR UNSPECIFIED TYPE, UNCONTROLLED

272.0 PURE HYPERCHOLESTEROLEMIA

272.1 PURE HYPERGLYCERIDEMIA

272.2 MIXED HYPERLIPIDEMIA

272.3 HYPERCHYLOMICRONEMIA

272.4 OTHER AND UNSPECIFIED HYPERLIPIDEMIA

278.03 OBESITY HYPOVENTILATION SYNDROME

327.23 OBSTRUCTIVE SLEEP APNEA (ADULT) (PEDIATRIC)

327.26* SLEEP RELATED HYPOVENTILATION/HYPOXEMIA IN CONDITIONS CLASSIFIABLE ELSEWHERE

348.2 BENIGN INTRACRANIAL HYPERTENSION

401.1 BENIGN ESSENTIAL HYPERTENSION

416.8 OTHER CHRONIC PULMONARY HEART DISEASES

425.8* CARDIOMYOPATHY IN OTHER DISEASES CLASSIFIED ELSEWHERE

530.11 REFLUX ESOPHAGITIS

571.8 OTHER CHRONIC NONALCOHOLIC LIVER DISEASE

715.15 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING PELVIC REGION AND THIGH

715.16 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING LOWER LEG

715.17 OSTEOARTHROSIS LOCALIZED PRIMARY INVOLVING ANKLE AND FOOT

715.25 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING PELVIC REGION AND THIGH

715.26 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING LOWER LEG

715.27 OSTEOARTHROSIS LOCALIZED SECONDARY INVOLVING ANKLE AND FOOT

715.35 OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING PELVIC REGION AND THIGH

715.36 OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING LOWER LEG

715.37 OSTEOARTHROSIS LOCALIZED NOT SPECIFIED WHETHER PRIMARY OR SECONDARY INVOLVING ANKLE AND FOOT

715.89 OSTEOARTHROSIS INVOLVING OR WITH MULTIPLE SITES BUT NOT SPECIFIED AS GENERALIZED

722.52 DEGENERATION OF LUMBAR OR LUMBOSACRAL INTERVERTEBRAL DISC

722.73 INTERVERTEBRAL DISC DISORDER WITH MYELOPATHY LUMBAR REGION

724.02 SPINAL STENOSIS, LUMBAR REGION, WITHOUT NEUROGENIC CLAUDICATION

724.03 SPINAL STENOSIS, LUMBAR REGION, WITH NEUROGENIC CLAUDICATION

* According to the ICD-9-CM book, diagnosis codes 327.26 and 425.8 are secondary diagnosis codes and should not be billed as the primary diagnosis.

 

 

Documentation Requirements

• Medical record documentation must support that all NCD requirements for Bariatric surgery are met as well as the additional requirements stated in this LCD.

• Medical record documentation must include the following: history and physical containing evidence of comorbid conditions, operative report containing a detailed procedure note, and office/progress notes documenting unsuccessful medical treatment for obesity.

• Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.

o The medical record must substantiate presence and severity of associated organic diseases requiring the treatment of obesity documented through appropriate physiologic testing and/or imaging.

o The patient’s medical record must include documentation of all required preoperative and postoperative evaluations and interventions and all other applicable coverage provisions required as outlined in this LCD.

o Patients who have a history of psychiatric or psychological disorder must undergo preoperative psychological evaluation and clearance and the patient’s record must include documentation of the evaluation and assessment.

o Documentation of smoking history, and that the patient has received counseling on the effects of smoking on surgical outcomes and treatment for smoking cessation, if applicable.

 

 

Utilization Guidelines

• It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.

o When services are performed in excess of established parameters, they may be subject to review for medical necessity.

• Repeat bariatric surgery is generally not reasonable and necessary.

o Claims for more than one bariatric surgical procedure may be submitted for individual consideration, and potentially covered when clinical circumstances demonstrate reasonability and necessity (such as replacing a defective device or correcting a complication in a patient who had met medical necessity for the original procedure and has achieved acceptable weight loss).

Sources of Information and Basis for Decision

 

Aarts EO, Janssen IM, Berends FJ. The gastric sleeve: losing weight as fast as micronutrients? Obes Surg. 2011 Feb;21(2):207-11.

 

Abbatini F, Capoccia D, Casella G, Coccia F, Leonetti F, Basso N. Type 2 diabetes in obese patients with body mass index of 30-35 kg/m2: sleeve gastrectomy versus medical treatment. Surg Obes Relat Dis. 2012 Jan-Feb;8(1):20-4. Epub 2011 Jul 13.

 

American Society for Metabolic & Bariatric Surgery. Updated Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. 2011. Available at: http://s3.amazonaws.com/publicASMBS/GuidelinesStatements/PositionStatement/ASMBS-SLEEVE-STATEMENT-2011_10_28.pdf .]

 

Bariatric Surgery: American Society for Bariatric Surgery Guidelines retrieved from http://www.lapsurgery.com on April 10, 2007.

 

Bayham, B., Greenway, F., Bellanger, D., Outcomes of the Laprarscopic Sleeve Gastrectomy in the Medicare Population, OBES SURG DOI 10.1007 , Published on line: 22 August 2012, Springer Science-Business Media, LLC 2012.

 

Bayham BE, Greenway FL, Bellanger DE, O'Neil CE. Early resolution of type 2 diabetes seen after Roux-en-Y gastric bypass and vertical sleeve gastrectomy. Diabetes Technol Ther. 2012 Jan;14(1):30-4.E.pub.2011Sep.20.

 

Bellinger, D.E., Greenway, F.L., Laparoscopic Sleeve Gastrectomy, 529 Cases Without a Leak: Short-Term Results and Technical Considerations, OBES SURG (2011)21:146-150 DOI 10. 1007 , Published on line: 4 Dec. 2010, Springer Science-Business Media, LLC 2010.

 

Brolin R E. Bariatric surgery and long-term control of morbid obesity. JAMA 2002 Dec; 288(22):2793-2796.

 

ECRI Institute Health Technology Assessment Information Service. Emerging Technology. Evidence Report: Laparoscopic sleeve gastrectomy for obesity. Plymouth Meeting (PA): ECRI Institute; 2011 October. Available at: https://www.ecri.org/Documents/Reprints/Laparoscopic_Sleeve_Gastrectomy_for_Obesity(Managed_Care)_October2011.pdf.

 

FCSO LCD 29317, Surgical Management of Morbid Obesity, 01/29/2013. The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

Leyba JL, Aulestia SN, Llopis SN. Laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the treatment of morbid obesity. A prospective study of 117 patients. Obes Surg. 2011 Feb;21(2):212-6.

 

Leivonen,M.K., Juuti,A., Jaser, N., Mustonen, H. Laparoscopic Sleeve Gastrectomy in Patients over 59 Years: Early Recovery and 12- Month Follow-Up, OBES SURG (2011)21:1180-1187 DOI 10.1007 , Published on line: 28 May 2011, Springer Science-Business Media, LLC 2011.

 

National Institute of Health. Bariatric Surgery Clinical Research Consortium, November 1, 2002

 

National Institutes of Health, National Heart, Lung and Blood Institute: Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks. Accessed via http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/bmi_dis.htm.

National Institute of Health. Bariatric Surgery Clinical Research Consortium, November 1, 2002

 

S. A. Brethauer et al., Systematic review of sleeve gastrectomy as staging and primary bariatric procedure, Surgery for Obesity and Related Diseases 5 (2009) 469–475

 

Stavros N. Karamanakos, MD, Konstantinos Vagenas, MD, Fotis Kalfarentzos, MD, FACS, and Theodore K. Alexandrides, MD, Weight Loss, Appetite Suppression, and Changes in Fasting and Postprandial Ghrelin and Peptide-YY Levels After Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Prospective, Double Blind Study (Ann Surg 2008; 247: 401–407)

 

Trailblazer Health Enterprises, LLC., Contract Number 04202, Local Coverage Determination (LCD) for Bariatric Surgical Management of Morbid Obesity - 4S-155AB-R7,(L26758),12/29/2011Revised Date]

 

01/29/2013

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

 

CMS LCD SURGICAL MANAGEMENT OF MORBID OBESITY