tci General Surgery Coding Alert - 2005 Issue 4

Reader Questions: Appeal Rejected Claim With 140-cm 'Limb'

Questions: Recently, the surgeon performed a gastroenterostomy (gastric bypass) with 140-cm limb. I submitted 43846, but the payer rejected the procedure as "experimental." Any suggestions?New Jersey Subscriber Answer: You should appeal the payer's decision. More than likely, the payer is using the now-outdated definition of 43846 (Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb [150 cm or less] Roux-en-Y gastroenterostomy).Prior to 2005, this code specified a short limb of 100 cm or less (rather than 150 cm or less). Payers seeing a limb of more than 100 cm were prone to deny...

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