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Posted 1/5/2023

January 2023 Edition

1. Presidential Messages

Teresa LaMasters, MD FACS FASMBS DABOM and Nate Sann, MSN FNP-BC deliver the monthly Presidential Video Message. Hear about the current state of the Society and upcoming events. 

ASMBS Presidential Message

ASMBS Integrated Health Presidential Message

2. Education & Events

Upcoming Webinars

3. Committee Updates

ASMBS Clinical Issues and Integrated Health Clinical Issues Committees Call for Membership Recommendations for Statements 2023

For 20 years the Executive Council and ASMBS Clinical Issues Committees have worked to provide timely evidence-based position statements on issues that affect the members and the field of bariatric surgery as a whole. The underlying goal of these statements is to provide guidance to the membership, hospitals, and third-party payers using the most current available evidence. Most importantly, the statements should reflect and address the concerns of our members.

We welcome your recommendations for future position statements that include any issues that affect your practices and your patients’ access, safety, or care. Please submit your recommendations for position statement topics to Leslie Vinson at . The deadline is Friday, February 10, 2023.

Thank you,

Jonathan Carter, MD
Chair, Clinical Issues Committee

Kasey Goodpaster, PhD
Chair, Integrated Health Clinical Issues Committee

Certified Bariatric Nurse (CBN) Practice Analysis (PA)

The Certified Bariatric Nurse (CBN) Practice Analysis (PA) has been completed and an abstract has been submitted to the 2023 ASMBS Annual Meeting. Thank you to all who completed the CBN survey as this work would not be possible without your input. We also wish to extend our gratitude to the Task Force members who dedicated several hours of work during the practice analysis process. We look forward to sharing the results in 2023.

4. Membership News

Lapsed Membership? Renew Today!

All memberships must be renewed annually. Membership is on a calendar-year basis (January – December).

Don’t let your membership expire!  Members can pay their 2023 dues online today by logging in at . Please contact us at  for questions or assistance. Thank you for your continued support of ASMBS!

5. Advocacy & Access to Care

2023 CPT Coding Book Changes

Beginning January 1, 2023, there will be changes to align hospital-based codes with the changes that were made to the outpatient side.  This primarily focuses on decreasing documentation components and basing code level primarily on medical decision making (MDM). The goal is to decrease administrative burden of documentation and coding, and to align CPT and Medicare. This should help decrease unnecessary documentation. A summary and link to extensive coding tables and required components can be found here:

Important changes:

  • Billing primarily based on MDM or time. Medically appropriate history and physical components are all that is required. There is no requirement for certain numbers of systems, past/family/social history. These should be documented to the level necessary for your diagnosis/treatment, but the complexity of the visit will come down to your MDM. Time requirements have increased, but they no longer require you to be “on the floor” for it to count. You can include time spent elsewhere doing documentation, record review, time spent on the phone with consultants/treating personnel.
  • All observation codes are deleted, but you may still may need to enter the patient’s status or location as observation. The resulting reimbursement may be affected, but the code used is the same. Discharge codes are for the admitting physician only. 99238 is a discharge less than 30 minute. 99239 is a discharge over 30 minutes. If you are a consultant on the case, then you can still bill for a regular hospital visit on the day of discharge.
  • The wRVU values decreased on all the initial visits, but the wRVU values increased for all subsequent visits.
  • Nearly all surgical patients will meet at least a medium-level of complexity of MDM, as long as your documentation explains your thought process, notes/testing/imaging reviewed, and potential risks of surgery. High levels of MDM require two categories of data amount/complexity. If you are reviewing labs/notes and you review the imaging yourself, that should meet two categories, but you need to document that as such. Reviewing your own notes or partners’ notes does not count as an external source, but other specialists within the hospital system or other hospitals would.
  • Diseases that pose a high risk of acute injury to life or bodily function can be interpreted as a high level of MDM. If a patient presents with a perforated viscus, and you review external notes, review the CT, and proceed with emergency surgery because the patient is at risk for deterioration or death, you will want your documentation to reflect a high level of MDM.
  • Items on the problem list should have treatment plans for it to count toward MDM.

In addition, there were significant changes to hernia codes. The open and laparoscopic wRVU values for ventral and umbilical hernias (but not ventral) were aligned to be the same and were decreased in value. There are also changes to how a hernia is measured, if there are multiple small defects within 10 cm of each other, they can be combined and counted as one larger hernia. If they are farther apart, then they are considered discrete hernias. The ACS published a webinar to review these changes:

Revised Aetna Policy for Obesity Surgery

The primary change is the decision to cover Single Anastomosis Duodenal-Ileal Switch (SADI-S), and Sleeve Gastrectomy with Single Anastomosis Duodeno-Ileal Bypass (SIPS):

“Single anastomosis duodenal-ileal switch (SADI-S) – no specific code.”

This means providers still need to rely on an unlisted code, but having the policy in place should remove some of the administrative burden of appealing claims.

Aetna added CPT 44202 “Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis [single anastomosis duodeno-ileal bypass].”

For members of plans regulated by the State of Maryland, qualifying comorbidities for persons with a BMI greater than 35 (I.A.1.b.) include: Hypertension; A cardiopulmonary condition; Sleep apnea; Diabetes; or Any life threatening or serious medical condition that is weight induced. The requirements for a supervised nutrition and exercise program (I.C.1) may be fulfilled by documented participation in commonly available diet programs, such as Weight Watchers or Jenny Craig; physician supervision is not required.

BCBS of ND Bariatric Policy Revision

No changes to coverage, but some minor coding changes in concert with CPT coding changes for 2023:

Added established CPT codes 43860 (Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; without vagotomy) and 43865 (Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, with or without partial gastrectomy or intestine resection; with vagotomy).

Added new CPT codes 43290 and 43291 which denote the placement and removal of gastric balloons. The plan does not cover gastric balloons. These are new codes for 2023.

Deleted the series of Category III codes 0312T – 0317T for Vagal Nerve Blocking (commonly used with the Maestro System). These codes are set to sunset in January 2023. The plan does not cover gastric balloons.

Excellus BCBS – Surgical Management of Obesity

Added the new 2023 CPT codes for gastric balloon insertion and removal (CPT 43290 and 43291) but indicate the procedure is not covered and deemed “experimental/investigational.”

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