Coding and Reimbursement for Weight Loss Surgery: Best Practice Recommendations

Kaplan, Lee M.; Fallon, John; Mun, Edward C.; Harvey, Alan M.; Kastrinakis, William V.; Johnson, Elvira Q.; Nierman, Robert S.; Keroack, Christopher R.

doi:10.1038/oby.2005.39

Cited by 10 publications

(8 citation statements)

References 40 publications

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“…Insurance company policies . The 2006 decision by the Centers for Medicare and Medicaid Services (CMS) to cover WLS has implications for obese patients, insurers, physicians, and hospitals that treat severely obese patients (27). The decision was predicated on evidence‐based criteria and best practice guidelines established by the NIH (28), the American College of Surgeons (29), and the American Society for Metabolic and Bariatric Surgery (30).…”

Section: Resultsmentioning

confidence: 99%

“…The Coding and Reimbursement Task Group reviewed the use and usefulness of billing codes for services related to WLS, and examined third party reimbursement policies for these services. The processes used for doing so have been previously described (2).…”

Section: Resultsmentioning

confidence: 99%

“…Evidence‐based best practice guidelines for coding and reimbursement for weight loss surgery (WLS) have been previously described (1,2). Earlier recommendations focused on issues that included procedural terminology, reimbursement policies, clinical objectives, data collection, tracking, and reporting systems.…”

Section: Introductionmentioning

confidence: 99%

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Best Practices in Policy and Access (Coding and Reimbursement) for Weight Loss Surgery

Shikora

Kruger²,

Blackburn

et al. 2009

Obesity

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To update evidence-based best practice guidelines for coding and reimbursement and establish policy and access standards for weight loss surgery (WLS). Systematic search of English-language literature on WLS and health-care policy, access, insurance reimbursement, coding, private payers, public policy, and mandated benefits published between April 2004 and May 2007 in MEDLINE, EMBASE, and the Cochrane Library. Use of key words to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. We identified 51 publications in our literature search; the 20 most relevant were examined in detail. These included reviews, cost-benefit analyses, and trend and cost studies from administrative databases. Literature on policy issues surrounding WLS are very sparse and largely focused on economic analyses. Reports on policy initiatives in the public and private arenas are primarily limited to narrative reviews of nonsurgical efforts to fight obesity. A substantial body of work shows that WLS improves or reverses most obesity-related comorbidities. Mounting evidence also indicates that WLS confers a significant survival advantage for those who undergo it. WLS is a viable and cost-effective treatment for an increasingly common disease, and policy decisions are more frequently being linked to incentives for national health-care goals. However, access to WLS often varies by payer and region. Currently, there are no uniform criteria for determining patient appropriateness for surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Best Practices in Policy and Access (Coding and Reimbursement) for Weight Loss Surgery

Shikora

Kruger²,

Blackburn

et al. 2009

Obesity

Self Cite

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“…An even more daring but still to be substantiated theory would have the cancer-cell-secreting factors that would mobilize bone marrow-derived cells to pre-metastatic sites [244]. Another hypothesis is the transmission of neoplastic properties from transformed to normal human stem cells [245].…”

Section: Cooperation “Swarm Intelligence” and “Emergence” In Cancermentioning

confidence: 99%

Systems biology of cancer: entropy, disorder, and selection-driven evolution to independence, invasion and “swarm intelligence”

Tarabichi

Antoniou

Saiselet

et al. 2013

Cancer Metastasis Rev

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Our knowledge of the biology of solid cancer has greatly progressed during the last few years, and many excellent reviews dealing with the various aspects of this biology have appeared. In the present review, we attempt to bring together these subjects in a general systems biology narrative. It starts from the roles of what we term entropy of signaling and noise in the initial oncogenic events, to the first major transition of tumorigenesis: the independence of the tumor cell and the switch in its physiology, i.e., from subservience to the organism to its own independent Darwinian evolution. The development after independence involves a constant dynamic reprogramming of the cells and the emergence of a sort of collective intelligence leading to invasion and metastasis and seldom to the ultimate acquisition of immortality through inter-individual infection. At each step, the probability of success is minimal to infinitesimal, but the number of cells possibly involved and the time scale account for the relatively high occurrence of tumorigenesis and metastasis in multicellular organisms.

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“…• That a committee be formed to examine such issues as standardization of the data collection system, the possibility of a tiered system (35), and a combined adolescent/ adult database;…”

Section: Recommendations (Category D)mentioning

confidence: 99%

Data Collection Systems for Weight Loss Surgery: An Evidence‐Based Assessment

et al. 2005

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. CELLA. Data collection systems for weight loss surgery: an evidence-based assessment. Obes Res. 2005;13:301-305. Objective: To evaluate the existence and efficacy of data collection systems for weight loss surgery (WLS) and establish evidence-based guidelines for the development of a statewide WLS registry in Massachusetts. Research Methods and Procedures:We conducted two systematic searches of English language literature in MED-LINE. The first was on data collection registries related to WLS; the second was an expanded search encompassing other surgical fields (e.g., cardiac and thoracic surgery) and registries (i.e., cancer). Fourteen articles were found to be pertinent. Data were extracted, and evidence categories were assigned according to a grading system based on established evidence-based models. Recommendations were derived from these literature reviews and expert opinion. Results: This task group found that there are no standardized data collection systems for WLS in Massachusetts (or any other states) and no mandated reporting of WLS-specific outcomes. We described existing WLS databases and systems in other surgical fields. Recommendations focused on the importance and feasibility of data collection for WLS and the need to conduct a pilot study and explore options for creating a statewide WLS database.Discussion: A statewide WLS data collection system would optimize patient care by enabling the collection, analysis, and dissemination of best practice data. A broad-based effort is needed to meet challenges involved in defining and implementing such a system.

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Coding and Reimbursement for Weight Loss Surgery: Best Practice Recommendations

Cited by 10 publications

References 40 publications

Best Practices in Policy and Access (Coding and Reimbursement) for Weight Loss Surgery

Best Practices in Policy and Access (Coding and Reimbursement) for Weight Loss Surgery

Systems biology of cancer: entropy, disorder, and selection-driven evolution to independence, invasion and “swarm intelligence”

Data Collection Systems for Weight Loss Surgery: An Evidence‐Based Assessment

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