Band migration (slippage), that cannot be corrected with manipulation or adjustment.Bowel perforation, including band erosion.adjustable gastric band, gastric bypass, or sleeve gastrectomy) or adjustable gastric band removal may be considered medically necessary when one or more of the following documented significant complications is present: Reoperation with revision of a bariatric procedure (i.e.Reoperation may be considered medically necessary if one of the following conditions is met: A licensed psychologist, psychiatrist, LCSW/LICSW, Licensed Masters level counselor, or NP in a behavioral health practice, documents the absence of significant psychopathology that can limit an individual’s understanding of the procedure or ability to comply with medical/surgical recommendations:.Preoperative evaluation to include both of the following:.Include assessment and counseling concerning weight, diet, exercise, and behavior modification.Be provided by an MD, DO, NP, PA, or RD under the supervision of an MD, DO, NP, or PA.Include at least three visits for medical supervision, occurring at intervals of no longer than four months apart, e.g., at the start, middle and end of the 6-month weight loss program.Occur during at least 6 consecutive months within the 24 months prior to the request for surgery.Documentation from the clinical medical records must indicate that the structured medical supervision meets all of the following criteria:
Comprehensive weight loss programs generally address diet, exercise and behavior modification, e.g., Weight Watchers. A comprehensive commercial weight loss program is an acceptable program component, but it must be approved and monitored under the supervision of the healthcare practitioner providing medical oversight. Documentation of active participation for at least 6 months in a structured, medically supervised nonsurgical weight reduction program.
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