From ASMBS Insurance Committee -- Matthew Brengman, MD, Committee Chair
Matthew Brengman, MD
The insurance committee often receives questions regarding coding of revisions and most frequently “Why isn’t there a code for Laparoscopic Gastric Bypass Revision?” This question, and more importantly its answer, is one of the highest priorities of the ASMBS and the insurance committee. There is a strong feeling within our organization that a CPT code would lead to greater access to reoperative procedures.
Obtaining a new CPT procedure code is an exacting process. The process is driven by a combination of need, procedure uniformity, safety and efficacy. In order to obtain a new CPT code, the application must demonstrate all components in a meaningful way.
At this point, we can effectively demonstrate need. Conservative estimates suggest 20 percent of patients following bariatric surgery have significant recurrent obesity. Whether mechanical, behavioral or a combination of both processes, these patients know the power of weight loss surgery and are tenacious advocates for reoperative procedures.
John Morton, MD
In order to address uniformity, safety and efficacy, from 2013-14, the ASMBS convened a task force, headed by Dr. John Morton, to review the current literature on reoperative bariatric surgery. Hundreds of articles were reviewed. The goal of the task force was to demonstrate the current evidence base for both safety and efficacy of reoperative bariatric surgery. The work product of this group has been published in SOARD (Brethauer SA, Kothari S, Sudan R, Williams B, English WJ, Brengman M, Kurian M, Hutter M, Stegemann L, Kallies K, Nguyen NT, Ponce J, Morton JM. Surg Obes Relat Dis. 2014 Feb 22.). While the safety and effectiveness of early reoperative intervention was apparent, the data for late reoperation for recurrent obesity was less definitive. In addition, the specificity of the reoperative procedure was difficult to define. This groundbreaking work has helped inform the leadership of the society and set into place new strategic initiatives.
Clearly we as surgeons believe in reoperative surgery –6 percent of our procedures are reoperative. We must collect the data to substantiate our desire for a CPT code. Our national data registries effectively capture the number of bariatric reoperations very well. However, these databases do not effectively capture the indication for the reoperation or what exactly was done at the reoperation. Because our current registry is CPT code driven, the lack of specific CPT codes limits the resolution of the database to provide meaningful data on occurrence, safety and weight loss outcomes for reoperative procedures directed at recurrent obesity.
Matthew Hutter, MD, MPH
To meet this need, the insurance committee, representatives of the reoperative task force and the MBSAQIP Data committee, headed by Dr. Matthew Hutter are working to create a prospective registry of reoperative surgery using codified language. ASMBS hopes to collect data on what exactly is being done at reoperative procedures, the complications associated with those procedures and most importantly the effect on weight and comorbid illnesses.
When we have this prospective data, we can begin to design CPT codes for procedures that are performed with some uniformity, frequency and that are safe and effective. Clearly this is a multi-year process. In addition, this process requires participation by surgeons who are performing reoperative bariatric surgery, especially for the indication of recurrent obesity. With continued effort and physician participation we hope to be able reach our goal of appropriate CPT codes for reoperative bariatric surgery.