9th Annual Association for Bariatric Endoscopy (ABE) Meeting | May 2024 ABEAM2024-Patient Seeking Insurance Coverage for ESG + Panel Discussion

Pdf Summary

Dr. Rashmi Advani, an expert in bariatric endoscopy, discusses a case of a 57-year-old woman seeking Endoscopic Sleeve Gastroplasty (ESG) for weight loss. The patient has a history of anxiety, sleep apnea, hypertension, and obesity with a BMI of 43.86. The document outlines the insurance approval process for ESG, including patient selection, pre-procedural workup, coding, and billing. Recommendations are provided for successful insurance approval, such as involving coders and administrators early on, understanding coding and billing codes, and working with hospital committees and payers. Specific HCPCS codes for ESG procedures are detailed, as well as strategies for obtaining insurance coverage and navigating appeals if needed. The importance of clinical documentation, appeals, and peer-to-peer discussions in securing insurance approval is emphasized. The document also highlights the efforts to establish specific HCPCS codes for ESG procedures, which have been granted New Technology status by CMS. Overall, the text serves as a comprehensive guide for healthcare providers seeking insurance coverage for ESG procedures, offering a step-by-step approach to navigate the insurance approval process successfully.

Asset Subtitle

Rashmi Advani, MD, ABOM-D

Keywords

Dr. Rashmi Advani

bariatric endoscopy

Endoscopic Sleeve Gastroplasty

ESG

weight loss

insurance approval process

patient selection

coding and billing

HCPCS codes

insurance coverage