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My day is Aug 7th. I am a band to sleeve revision. So ready. Laura

@@jhayden1 Had a successful band for 7 years, and just recently revised to a sleeve (preventive more than necessary) but yes, unfortunately I remember those days before the first fill. Some people had restriction with just the band alone, unfortunately, I was not one of them lol. You'll also be having quite a bit of false hunger sensations and that's from the inside healing and/or acid. Congratz and am excited for you. I loved my band

very very very bad idea. Lap bands have terrible complications and as of right now a 50% failure rate. the odds are extremely high you will do irreversible damage. there are Bariatric patients out there who have done band over RNY (never heard it for sleeve) and they can never have another revision because it could be fatal for them. my local center of excellence currently has an 80% removal rate...80%. there are countries that have banned the band. the conventional revision path from a sleeve for lack of weight loss is either RNY or DS (the sleeve is the first stage of the DS). Honestly, I"m shocked any doctor would recommend a band. my doctor says any doctor still putting them in should be sued for malpractice.

I got to that point about 4 years in or so. Nothing I did would get me to stay under the 300 mark. Ultimately, I was revised to the bypass. My surgeon advised me that the Lapband was over hyped and under performed, that 2 of the largest manufacturers have sold off or stopped making new or replacement parts for their versions of the bands. When they removed the band, even though I didn't have any major issues going to the revision, the band was 100% encapsulated in scar tissue and took my surgical team more than 3 times longer to remove it than it should have taken. I'd hate to think what would have happened if I left it in!

Hi all, I had my Lapband revision with Gastric Bypass on 9/5/17. Thankful I only had to spend one night in the hospital. Walking good since the day of surgery, and have slowly worked up to walking outside around our block twice a day! [emoji5] I was in a car accident 4 years ago, multiple health issues since, and last 2 years consistently gained wt. I was miserable prior to surgery, felt like you could pop my abdomen with a pin (looked like 9 months pregnant). I am diabetic, was on Trulicity weekly injection several months prior to surgery, which is the main reason for having the surgery - hopefully help reverse diabetes, get healthy and feel better physically. I'm a disabled nurse now (pediatric/NICU). I know this will/is a journey with ups & downs, and is a "tool" - I have to do my part, but thankful surgery went smoothly and I'm on my way to better health! God bless each of you on your journey! HW 205 SW 188 Post op from IV fluids wt. 197 CW 181 Sent from my SAMSUNG-SM-G870A using BariatricPal mobile app

I was banded with plication in August 2012. I have had two fills so far. I have not lost any weight since November. I follow my diet, exercise etc. Now I am having pain in my stomach and left side around to my back. It gets worse when I eat. I went throught Dr. Wilkenfeld in Conroe and am finding out that he doesn't really care about you after your surgery. Is it too soon to consider another surgeon and possibly a revision to sleeve? Will another surgeon even see me? I wish I knew what I know now about him before using him and having the lapband. He talked me out of the sleeve and I wish I had just changed doctor's then.

I'm sorry. . I guess it's better to be safe than sorry but that won't make you feel better. What a bummer. I did just see someone who had to go back for a revision 6 months out of their sleeve because of scar tissue. This might save you a different complication later. Still, I'm bummed for you!

First want to say that people who have the band can share some of their experiences- good and bad. The band was not good for me but great for my dad. I think it's great to understand ALL options when gong in for a surgery. I went in with blinders as I didn't want anything that was going to change my insides and many say the same. There are plus and minuses from all surgeries and really need to be aware of options that's why they are there. By the way- I was handed 2012 lost 25 lbs gained back 3 times that amount and now revised to sleeve 5 days ago. Whatever a person decides on they should view and understand ALL.

I got my band in Dec 09 and I lost 40+lbs but then nothing. Band was tight bc like u I would puke probably 3-4 meals a week. At 211 I just felt like I failed though much healthier than 260. I went to Mexico for a revision to gastric sleeve. The sleeve surgery was 5k and I paid an extra $500 for band removal. Best decision! I am 6 weeks or so out and down to 186 pounds. Good luck whatever u decide!

8000 steps is pretty high for being just a few days out of surgery. Your body needs to rest and heal. It's been several years since I had surgery, but I think I mostly walked around my house a little the first three or four days, then did a jaunt around the block every day for a few days after that. It's good to be up and moving, but don't push yourself too much - again, your body needs to heal. as far as poop, it often takes a good week for the first one (there's not much in there yet), and the first one tends to be a doozy. A lot of us start taking stool softeners a couple of days ahead of it to prepare for it. After that, a minority of people experience occasional diarrhea, but most experience constipation, often chronic (it's due to the high protein diet plus the iron and calcium (if you're taking those). I still take a capful of Miralax every morning to keep on top of it. watch out for reflux - I'm a little surprised your surgeon recommended VSG since that's been known to make GERD worse, but that's not the case for everyone. But just keep tabs on it and manage it if it doesn't resolve or gets worse (a minority get it so badly they end up getting a revision to RNY, but for most, it can be managed with PPIs). You just don't want that to get out of control - but again, you may not have issues with it. Some people have said theirs even got better after surgery, so you never know.. I haven't seen many posts about hiccups, so I don't know how common that is, but it doesn't surprise my since your stomach's been sliced and diced. And the painful transitions (when you go from lying down to standing up, or whatever) - yep, that's very common. That's really the only time I had pain. It felt like I'd just done about 1000 crunches. that went away after a week or so, I think. sounds like things are going well over all, though. Welcome to the losers' bench!

Katy, I am sorry you still have some pain! My insurance was reluctant to pay because the original request to revise had made it sound like we needed to revise the pouch rather than te port. Once it was clarified ( through filing a grievence) they approved it. I had a talk with the surgeon before we went to the OR the next time and let him know that, whever he was planning to move it to... I did not want to be able to see or feel the port after this operation. He did a good job of making it happen. Afterward he said that what had happened was that 2 of the 4 stitched areas securing the port had broken free, so instead of laying flat, it was standing up... And in that position there was no way to fill it as the needle was entering parrallell to the port. My real concern now is that after being banded in May and not being ant to get it filled until November. I worry that I msy not be inthe right "mindset" to be successful. At first it's new, and you are sure you have found the thing that is really going to work for you. Then you get it done... And I lost 20 lb... But it was through dieting rather than the lap band doing much... Then that tapered off... And after a while it felt to me like the lap band was going to be one more failed diet attempt. Now that I have had my first fill i am trying to get back the optimism I had at the beginning... But there is still the self doubt that makes me afraid this too will not work. I am really hoping that I will see results that will give me some hope that this time things are going to be different.

I am a PA with many years experience in AGB. Was the erosion found on an EGD or a barium swallow? Did you have any port infection or any other surgical infection in your past history? If there is truly an erosion, the band must be removed and another should not be placed in the future. A gastric sleeve would be risky and many surgeons will not attempt it. Bypass may be an option but consult with a surgeon with experience in doing bariatric revisions. You shouldn't have to regain your weight back, a letter from a surgeon that reads "in order to preserve his excellent weight loss and return of comorbidities, a revision surgery should be performed" would help. I tell my cash pay patients they better have at least 10K saved up for future complications.

Pittsburgh also, Monroeville area. I'm a revision to lose the next 100+. I had a VBG in 98 and lost 250, gained 50 back. I am 349 at 7 days post op RNY.

http://mcgs.bcbsfl.com/ Note the timeline on this: 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows: <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested. Gastric surgical procedures for the treatment of clinically severe obesity include: <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band. WHEN SERVICES ARE COVERED: Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language. NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director. Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met: The member: <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months <LI class=bulletedList-1>has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention; does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder). The following procedures may be considered medically necessary when the above criteria has been met: Vertical-Banded Gastroplasty (CPT code 43842) Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. Roux-en-Y Gastric Bypass (CPT code 43644, 43846) Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include iron deficiency anemia, vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach. Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774) Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows: "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives." Biliopancreatic Bypass with Duodenal Switch (43845) The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment). WHEN SERVICES ARE NOT COVERED: Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits. Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity: Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847) Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. This procedure consists of the following components: <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant. Mini-Gastric Bypass (no specific CPT code) Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used. NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass. The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes: <LI class=bulletedList-1>jejunoileal bypass <LI class=bulletedList-1>gastric wrapping Garren-Edwards gastric bubble. BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9 Diagnoses Codes That Support Medical Necessity: 278.01 Morbid obesity REIMBURSEMENT INFORMATION: Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS: Federal Employee Program (FEP): Follow FEP guidelines. State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS: Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum. Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity. Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume. Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion). Gastric bubble: see definition of Garren-Edwards gastric bubble. Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine. Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater. Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES: Gastric Bypass Revision, 02-40000-11 OTHER: Other index terms for gastric surgery: Adjustable gastric banding Bariatric surgery Gastric bypass surgery Lap-Band System Mini gastric bypass Billroth II Long limb gastric bypass Roux-en-Y Scopinaro Vertical banding REFERENCES: <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition) U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01 COMMITTEE APPROVAL: This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION: 10/15/99 Medical Coverage Guideline developed. 09/15/01 Various revisions. 01/01/02 Coding changes. 10/15/02 Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services. 05/15/03 Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria. 09/15/03 Coverage criteria for psychological testing/counseling revised. 10/15/03 Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm. 01/01/04 Annual HCPCS coding update. 04/01/04 2nd Quarter HCPCS coding update; added S2082 and S2083. 07/15/04 Scheduled review; no changes. 01/01/05 HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085. 05/15/05 Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged. 01/01/06 Annual HCPCS coding update (added 43770-43774; deleted S2082). 04/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references. 05/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older. Private Property of Blue Cross and Blue Shield of Florida. This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

Originally Posted by Lap_dancer From BCBS Association (corporate) . 5. The improvement must be attainable outside the investigational settings. The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs. Based on the above, laparoscopic gastric bypass meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. http://www.bcbs.com/betterknowledge/.../20/20_15.html Source found at above website. Yeah, but isn't this just for gastric bypass? I couldn't find anything about gastric banding in this document. JB .................................................................................................. Airman, think of doing searches on this subject like a crossword puzzle. Just because you have a th_ _ K doesn't mean the word is think. You won't find some of the information easily. You should keep track of your searches via your search engine history. Book mark things, reduce the screen and open up another window to continue a new search. Open WORD and copy and paste links and language from documents. ( I do this all the time when I am researching). I'm not an insurance agent but here is what I have learned about Blue Cross and Blue Shield. Blue Cross and Blue Shield (BCBS) is like a mall. Inside the mall you have different stores that you can shop from. So you get Blue Cross, Blue Shield, Blue, Blue Options, ... Google is a good friend. Please utilize this in your efforts to gain information available to you. Google entry from me was: BCBS South Carolina weight loss surgery HITS: Suburban Surgical Care Specialists, S.C. - Bariatric Surgery Vanderbilt Center for Surgical Weight Loss, Exclusion List The Next Step for Weight-Loss Surgery Blue Distinction Centers for Bariatric Surgery That one sounds good, I think I'll try it......... (thinking, if BCBS doesn't cover it and thinks Lap Band is experimental, I won't find a hit on my search ) Inside this HIT I see it is the BCBS site, I'l go to SEARCH and type in GASTRIC HIT: Displaying results 1 - 5 of 5 items found. 1. TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity (Web Page; Thu Jan 25 15:43:00 EST 2007) EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures,... Description: Laparoscopic Adjustable Gastric Banding for Morbid Obesity 2. Laparoscopic Gastric Bypass Surgery for Morbid Obesity (Web Page; Mon Oct 30 15:26:00 EST 2006) Assessment ProgramVolume 20, No. 15 February 2006Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net... Description: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. 3. Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass (Web Page; Mon Oct 30 15:27:00 EST 2006) Assessment ProgramVolume 20, No. 5 August 2005Executive Summary Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities.... Description: Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities. HIT: TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass is the most common procedure performed in the U.S., and offers the most favorable benefit/risk ratio among established procedures. Laparoscopic adjustable gastric banding (LAGB) is an alternative technique that has the potential advantages of being less invasive and reversible. Prior TEC Assessments have concluded that LAGB does not meet the TEC criteria. Objective: To review the available evidence on whether LAGB results in similar improvements in health outcomes as does open or laparoscopic gastric bypass (GBY). Search strategy: MEDLINE search for the period of 1980 through September 2006, supplemented by hand search of bibliographies and search of Cochrane database. This goes on but it tells me that they are NOT calling it "investigational." PRINT AND SAVE 1. The technology must have final approval from the appropriate governmental regulatory bodies. Bariatric surgery itself is a procedure and is not subject to U.S. food and Drug Administration (FDA) regulations. However, certain devices that may be used as part of the procedure may be subject to FDA approval. The Lap-Band® system received premarket application (PMA) approval by the FDA in June 2001 for use in morbidly obese patients. 2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes. The evidence is sufficient to permit conclusions concerning the short-term safety and efficacy of LAGB in comparison with GBY. Weight loss at 1 year following LAGB is substantial, in the range of 40% EWL, although less than that seen following GBY. The short-term complications of LAGB are very low, with serious short-term complications being uncommon, and mortality exceedingly rare. Rates of short-term adverse events, including serious procedural complications and mortality, are lower for LAGB compared with GBY. Same page, further on down the page. Airwayman, I could truthfully sit here for the next span of time and do this research for you but in the end, it teaches you nothing on perserverance. I am a teacher. I teach my students that perserverance pays off. In the frustration of learning, there is victory in the end. *I began my own Quest knowing NOTHING about the surgery, my own insurance plan nor how the process works. After six months, I can answer pretty much any question thrown my way. Tomorrow I will get my chance to educate the insurance committee at work. They were told "gastric surgery is not covered by Blue Cross", I beg to differ. http://mcgs.bcbsfl.com/ Search: Medical Coverage Guidelines BCBS HIT: 1.(61.06% Relevant)Gastric Electrical Stimulation... peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling 64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver 0155T Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature ...2.(59.05% Relevant)Gastric Bypass Revision... gastrectomy or intestine resection; with vagotomy 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only 43887 Gastric restrictive procedure, open; removal of subcutaneous port component only 43888 Gastric restrictive procedure, open; removal and replacement of ...>>3.(58.83% Relevant)Surgery for Clinically Severe Obesity... or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the ... 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION. Non-Covered Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines Other References Updates DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows:

I don't exactly regret getting my band, but I do regret not being respectful of it and not treating it like the powerful tool it was. I had it removed in October 2015 and am proceeding with revision to gastric bypass on 4/18. The band had slipped and was causing lots of problems. My surgeon and I decided to proceed with the revision. I know it's a drastic step but I have gained lbs of the 50 I had lost in the past 5 months. As an aside, my surgeon, says he rarely used the band anymore; he sees too many complications like mine. I'm nervous but happy and excited.

Hi. 👋 I’m 11/29 revision to sleeve.

A friend of mine went to MX to get the sleeve. She met a gal at the hospital that had the band and wanted it removed and a revision to a sleeve because she was not losing weight. When the surgeon went in to remove the band, he said there was no way he could do a sleeve, as the band had done damage to her stomach that was not repairable. She ended up with no band, and no revision surgery.

@Sherrie ScharbroughI don't have a lot of weight in my upper stomach. Insurance is paying for mine as well. I'm sorry you had such a bad experience! They are doing a mons lift as well. This is kind of an in between surgery as I am not at goal yet but need this skin taken off now. As long as I don't have a terrible experience I will most likely need a revision tummy tuck that will focus more on shaping. Thank you! @Julie nortonThanks! I'm hopibng it only takes me 10 days to feel better! I don't usually do well after surgery @Suaniya Thank you!!

My first 50 lbs lost someone said "Pam did you drop a couple of pounds?) .grrrrrrr. well I probably did wear my pants a bit on the comfy side before but sheesh, 50lbs? Funny thing is 15 lbs more and then people were more like omg. Pammmmmmm you lost so much weight. I think your body hits a place where it changes. Then Id lose another 30 and no one would notice then 5 lbs more then it would be omg your gonna be skinny soon. Now after 100 lbs every 10-15 lbs is kinda noticable and my clothes changes. In fact I had a revision in early October and ive gained 35 lbs back and none of my clothes fit. sad!!!

Perhaps discussing with your surgeon, different surgery types that might be available for revision if you are really not happy with the band and think that you won't be compliant with a replacement. Either way just leaving it there especially if it is not working or disconnected can't be a good thing, so follow up with your surgeon or find one that has more extensive support and see what options are out there. Don't just let it sit.

Hi AussieGirl - what happened with the lap band? You had sleeve surgery so just wondering why the band didn't work?I had the lap band and it failed after a few years, it kept playing up, everything would get stuck, even Water.. i started getting really bad pain near the port site.. i had port replacement and a band change and it was still causing issues, so i asked them to take it out... i couldn't live with the pain any longer as well as starving because nothing would stay down. I waited 12 months.. and during that time i gained weight, even though i was eating well and exercising, i had my metabolism tested and because of the complications i had reset my metabolism to a low point, so the doctor suggested that i get the sleeve to enable me to stay at that lower rate without being hungry... basically i can not go above 800 calories for life without gaining. It sucks.. and i might never get back down to my original weight... but i am finally losing... i am a slow loser, but i am hoping ill get there eventually. This is why i always advise people to increase their calories and not to starve themselves, because it can really screw up your metabolism. That sucks - I keep hearing of people on here having to get revisions to sleeve. I don't think I could deal with the lapband, simply because of the maintenance on it, and the port. Then again, the sleeve is permanent - no going back. I'm about 90% there when it comes to getting used to that idea - I too am a slow loser. Always was and in fact the ONLY way in my life that I could keep my weight down at all, was to work out 6-7 days a week, most days 2+ hours at high intensity, and eat 1200-1400 calories, even with all that exercise. If I stopped for a day or two for some reason - lbs were coming back on - that quickly. And once you marry and have kids, there just is not the time to maintain that kind of rigorous schedule obviously. I could eat better than I do, eat regularly cause I don't, diet AGAIN - but I just will not go through that again and then gain it all back again +extra. So I've put on more weight. Maybe it was you in here that said to keep increasing your calories after the sleeve to a point where you can top off at 1200-1400 cals per day? Otherwise you're stuck at low cals forever. It's encouraging to hear that you're losing again though!

Hello! I’m scheduled for a revision on 8/8 as well! I had a VSG 18 months ago and have had terrible acid reflux and developed a hiatal hernia. I only lost about 40 lbs after my sleeve, too. I’m hoping the revision will not only take care of the acid reflux but that I’ll lose 50 more lbs! I’m keeping my fingers crossed. I hear that weight loss is much slower after a revision so I’m hoping I don’t get really frustrated. Maybe we can be surgery buddies and keep in touch! Keep us all posted on how things are going. I start my liquid diet on Monday. Good luck with everything!😊

You are six weeks in to this and never experienced a regain? or are you a revision?

do your research and don't depend on comments from anyone . each person has to make their decision based on how they think they will do. The difference is how drastic you want to go. Lapband is no walk in the park either and unless your are sure you can be pretty compliant you may opt for something else. I did not want to have a radical rearrangement of my intestines or removal of my stomach. My husband had esophageal cancer last year and keeping his nutrition up was a major problem. Had he only had 20% of his stomach I doubt he would have survived. long term thinking is important. Lapband is revisable or removable if necessary. the other surgeries are for life.