Notification



Notification Issue Date:



Policy Attachment



Attachment to Policy # 11.03.02s


Attachment:C

Policy #:11.03.02s

Description:ICD-10-CM codes

Title:Bariatric Surgery


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



COMMERCIAL AND MEDICARE

THE FOLLOWING CODES REPRESENT DIAGNOSES THAT SUPPORT A BMI OF 35 OR GREATER

E66.01 Morbid (severe) obesity due to excess calories

Z68.35 Body mass index (BMI) 35.0-35.9, adult

Z68.36 Body mass index (BMI) 36.0-36.9, adult

Z68.37 Body mass index (BMI) 37.0-37.9, adult

Z68.38 Body mass index (BMI) 38.0-38.9, adult

Z68.39 Body mass index (BMI) 39.0-39.9, adult

Z68.41 Body mass index (BMI) 40.0-44.9, adult

Z68.42 Body mass index (BMI) 45.0-49.9, adult

Z68.43 Body mass index (BMI) 50.0-59.9, adult

Z68.44 Body mass index (BMI) 60.0-69.9, adult

Z68.45 Body mass index (BMI) 70 or greater, adult

Z68.54 Body mass index (BMI) pediatric, greater than or equal to 95th percentile for age


THE FOLLOWING DIAGNOSIS CODES DESCRIBE COMPLICATIONS OF AN INITIAL BARIATRIC PROCEDURE

K91.2 Postsurgical malabsorption, not elsewhere classified

K91.30 Postprocedural intestinal obstruction, unspecified as to partial versus complete

K91.31 Postprocedural partial intestinal obstruction

K91.32 Postprocedural complete intestinal obstruction

K91.81 Other intraoperative complications of digestive system

K91.89 Other postprocedural complications and disorders of digestive system

K95.01 Infection due to gastric band procedure

K95.09 Other complications of gastric band procedure

K95.81 Infection due to other bariatric procedure

K95.89 Other complications of other bariatric procedure

T81.40XA Infection following a procedure, unspecified, initial encounter

T81.40XD Infection following a procedure, unspecified, subsequent encounter

T81.40XS Infection following a procedure, unspecified, sequela

T81.41XA Infection following a procedure, superficial incisional surgical site, initial encounter

T81.41XD Infection following a procedure, superficial incisional surgical site, subsequent encounter

T81.41XS Infection following a procedure, superficial incisional surgical site, sequela

T81.42XA Infection following a procedure, deep incisional surgical site, initial encounter

T81.42XD Infection following a procedure, deep incisional surgical site, subsequent encounter

T81.42XS Infection following a procedure, deep incisional surgical site, sequela

T81.43XA Infection following a procedure, organ and space surgical site, initial encounter

T81.43XD Infection following a procedure, organ and space surgical site, subsequent encounter

T81.43XS Infection following a procedure, organ and space surgical site, sequela

T81.44XA Sepsis following a procedure, initial encounter

T81.44XD Sepsis following a procedure, subsequent encounter

T81.44XS Sepsis following a procedure, sequela

T81.49XA Infection following a procedure, other surgical site, initial encounter

T81.49XD Infection following a procedure, other surgical site, subsequent encounter

T81.49XS Infection following a procedure, other surgical site, sequela

T81.89xA Other complications of procedures, not elsewhere classified, initial encounter

T81.89xD Other complications of procedures, not elsewhere classified, subsequent encounter

T81.89xS Other complications of procedures, not elsewhere classified, sequela

T85.518A Breakdown (mechanical) of other gastrointestinal prosthetic devices, implants and grafts, initial encounter

T85.518D Breakdown (mechanical) of other gastrointestinal prosthetic devices, implants and grafts, subsequent encounter

T85.518S Breakdown (mechanical) of other gastrointestinal prosthetic devices, implants and grafts, sequela

T85.528A Displacement of other gastrointestinal prosthetic devices, implants and grafts, initial encounter

T85.528D Displacement of other gastrointestinal prosthetic devices, implants and grafts, subsequent encounter

T85.528S Displacement of other gastrointestinal prosthetic devices, implants and grafts, sequela

T85.598A Other mechanical complication of other gastrointestinal prosthetic devices, implants and grafts, initial encounter

T85.598D Other mechanical complication of other gastrointestinal prosthetic devices, implants and grafts, subsequent encounter

T85.598S Other mechanical complication of other gastrointestinal prosthetic devices, implants and grafts, sequela

T85.612A Breakdown (mechanical) of permanent sutures, initial encounter

T85.612D Breakdown (mechanical) of permanent sutures, subsequent encounter

T85.612S Breakdown (mechanical) of permanent sutures, sequela

T85.618A Breakdown (mechanical) of other specified internal prosthetic devices, implants and grafts, initial encounter

T85.618D Breakdown (mechanical) of other specified internal prosthetic devices, implants and grafts, subsequent encounter

T85.618S Breakdown (mechanical) of other specified internal prosthetic devices, implants and grafts, sequela

T85.622A Displacement of permanent sutures, initial encounter

T85.622D Displacement of permanent sutures, subsequent encounter

T85.622S Displacement of permanent sutures, sequela

T85.628A Displacement of other specified internal prosthetic devices, implants and grafts, initial encounter

T85.628D Displacement of other specified internal prosthetic devices, implants and grafts, subsequent encounter

T85.628S Displacement of other specified internal prosthetic devices, implants and grafts, sequela

T85.638A Leakage of other specified internal prosthetic devices, implants and grafts, initial encounter

T85.638D Leakage of other specified internal prosthetic devices, implants and grafts, subsequent encounter

T85.638S Leakage of other specified internal prosthetic devices, implants and grafts, sequela

T85.692A Other mechanical complication of permanent sutures, initial encounter

T85.692D Other mechanical complication of permanent sutures, subsequent encounter

T85.692S Other mechanical complication of permanent sutures, sequela

T85.698A Other mechanical complication of other specified internal prosthetic devices, implants and grafts, initial encounter

T85.698D Other mechanical complication of other specified internal prosthetic devices, implants and grafts, subsequent encounter

T85.698S Other mechanical complication of other specified internal prosthetic devices, implants and grafts, sequela

T85.79xA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter

T85.79xD Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, subsequent encounter

T85.79xS Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, sequela

T85.9xxA Unspecified complication of internal prosthetic device, implant and graft, initial encounter

T85.9xxD Unspecified complication of internal prosthetic device, implant and graft, subsequent encounter

T85.9xxS Unspecified complication of internal prosthetic device, implant and graft, sequela


THE FOLLOWING CODES REPRESENT BARIATRIC SURGERY DEVICE ADJUSTMENTS:

Z46.51 Encounter for fitting and adjustment of gastric lap band

Z46.59 Encounter for fitting and adjustment of other gastrointestinal appliance and device

Version Effective Date: 10/01/2019
Version Issued Date: 10/21/2019
Version Reissued Date: 01/09/2020



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