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So O.K., I need a kick in the butt too! I have been doing so well, workingout 5 times a week and eating right all day and then at 9:30 at night, I start to feel like I need to snack! I graze on this and that and I jknow it destroys all the work I have done all day! This is the hard part for me because everyone is talking about how good I look and how much weight I have lost and I begin to feel like I can ease up for just a moment. I deserve it. That is the behavior that had nme gain weight year after year! I'm with you Pizz and Bad I am putting a moratorium on everything not on the list. I am 5 lbs from my revised, revised 6 month goal and I am 9 days out. I go in for my 6 month post op on Mar 4 so that gives me a few extra days to knock off these 5 lbs. Well, I had to get that out! I'm going to bed to save myself from food! Val

I'm fortunate, our insurance is going to cover the band removal (or if they can, it will be fixed, however they will not put in a new one as they do not cover revisions). I really like the surgeon we are working with. I lost 60 pounds with the band and have gained back 30. However one of the greatest gifts that the band gave me was that it gave me the freedom to concentrate on other areas of my life. food and weight no longer took up so much of my life force. With the weight loss and the freedom from compulsive eating, I was liberated to spread my wings and soar. It has provided me with a beautiful new life. I'm married to my Beloved husband, I have a career that I LOVE, fantastic friends, and I really and truly like and love who I am. So now, this new me, will be able to help me recalibrate should the band be removed. I'm not going to descend into darkness again. There's way too much light in my life now. I plan on taking really good care of myself... and pray for divine assistance :sad_smile: And should I be able to keep my band, then I'll Celebrate that, too!

Teri, I understand the Dr sucking, for me it was after the surgery they treat you different. And after this last farce, he was there and just stared at me. Why would I just show up, and on my 1 year anniv yet? Good Greif give me a break, he keeps you waiting hours, you think I am going to take off work for nothing! Enough of that, it just pisses me off again. So what is the revision? Are you going to have it removed? Let me know, I think of you a lot and do hope that things start working your way. Take care Debie

Hey Lil Miss Diva! It has been much too long since I`ve checked in here! My band has been empty for awhile, my port was leaking. So I haven`t lost any either. But I got it revised on may 24th and also had a hernia repair and a tummy tuck! they took off 9 pounds for the tummy tuck. yay! I`m so excited to not have my big flab of belly anymore. I`m anxious to be able to work out again. any problems with your band?

Dang tap! That's probably the longest post Ive seen in awhile! Awesome!! So nice to see you're back, i've missed ya! Been quiet since you were gone. :frown: Girl the 5 lbs. is actually not bad. I can do that in one single "bad" weekend. You'll lose it quick, so mount up! We're here to see you through. As for me, nothing much has changed. I have been looking deeper into the revision, but I'm thinking that's going to be a ways down the road. Even if I get to goal with my band years from now, I know I can never go back to just nothing. I can gain way too easily and I really don't want to be right back where I left off or worse. I cancelled my unfill appt and instead made an appointment to see my surgeons nutritionist. Maybe I just need to be lead back into the right direction? We'll see how that goes. I know I am having issues though because I woke up almost all night the other night with my coughing fits. Some last night too. :-( I'm going to try not eating too late and see how that holds. Shiny, at least you're doing you're workouts! I know it must be really very frustrating though, battling the sweet demon. So sad!! I wish I could just slay him once and for all and he is never able to return. He's like Jason from Friday the 13th!! Just when you think you've conquered him... well... you know how it goes. I'm on part 299 right now! Ezma, I wish I had some good advice for you with your son. But, you're a great Mom and I'm sure you'll get it right. I never had a lot of boyfriends growing up and held down my virtuosity for a bit longer than other girls my age and for the time it was in. Now a days it would seem like I was an old woman! lol What I remember though is that my Mom would always be open with the discussion and always tried to tell me the things boys would do to try to convince me. She would also tell me that I'm special and I should wait for someone that I loved - and when the time came, just to be open with her about it. It wasn't too weird ( I mean it was a little but I'm glad she did it).. anyway what I'm saying is, just try talking with him a little bit. My Mom didn't mind talking to my brothers either. It can't hurt and even if he doesn't receive it well, at least you know you did what you could. :eek: Ok well, hope everyone's doing good for a Monday. I'm slammed at work and I've had this spreadsheet due forever. I'll check in again soon! :wink3:

Okay, I finally caught up on all the back posts. How wonderful to see everyone posting here. What I'm seeing is a lot of us settling into real life and trying to figure out how to incorporate the changes we made from having a band into what our daily lives hold. It is certainly a process and I am glad to have the support of you all during it. Crystal, if you truly think the band can't work with your stomach properly have you looked into other options like a gastric sleeve? I've read quite a bit about that on this site. I have had virtually no problems with my band, but if i ever did have complications I would seriously consider revising from band to sleeve. I think a sleeve would eliminate the being-too-tight thing. It's funny, but at first I wanted the band because it was reversible if needed. Now that I've lost so much weight, there's no way in the world I want this reversed! So a more permanent solution is a more realistic option. On running. It surprises me that it's something that I've gotten into. I hated running. Couldn't figure out why someone would do that on purpose unless a large animal was chasing them. But as I started walking I felt empowered. So eventually I tried running a few steps. It freed me from this pre-conceived notion that I couldn't run and was too weak to ever do so. I was strong enough to do that little bit and strong enough to add to it day by day. I used the couch to 5K and thought it was pretty challenging. I didn't know any couch potatoes that could do the amount of walking/running that it prescribes to begin with. But eventually I got there and was able to progress a bit at a time. Like Angie said, I don't know if you'd really call what I do running, it's more what most people would consider jogging, but I call it running because to me that's what I'm doing. I'm not sprinting, but I'm running at a pace that I can sustain for 2 miles or more. Sometimes, though, my workouts fizzle out. I went to the gym yesterday, having had a great run on Monday, and just couldn't do it. I ran for about 5 minutes and just didn't have the oomph to keep going. My goal is 45 minutes of exercise, so walking counted. I got tired of doing the walking eventually and moved to the stationary bike for the last 13 minutes. :biggrin: Today we are going to walk to the library for our exercise. I think it's about a mile away. We'll see how long it takes with the kids in tow. There's a mom and toddler group, followed by a mom's group with free babysitting. I'm looking forward to it. I hope you all have a fabulous day!

Hi, I share your pain. I too have had missing cc's over the past year. All kinds of tests and my Dr. says I am a mystery. I go from no restriction to tight to no again. Now I have constant heartburn, hicupping and reflux. My Dr. put in for band to sleeve revision and my insurance approved it but I am very scared to go through all this again. I am down from 207 to about 160 however I have had nothing but failure and discomfort from the band. I really have to weigh my options. Good luck to you, I really hope it all works out.

@stephh I seem to have dropped off the spreadsheet. My starting weight was 204, my goal is 194. Today I am 197. I guess I need to revise my goal. Let's make it 190. Thanks! Lclemur. How do you keep track of all of us? Were there this many on the last challenge?

Hi When did you have surgery? I was Dec 11th and feel like I'm losing very slowly, to be expected after band revision...

I also went to this site referenced above and read all the fine print. I noticed that under the section marked "Public Comments," this comment and rebuttal was printed: "Comment: Another commenter agrees with the changes as well but recommends that the list of obesity-associated co-morbidities be a complete, inclusive list to prevent inappropriate denial of service. The commenter goes on to state that covered procedures should include the laparoscopic vertical sleeve gastrectomy and duodenal switch procedures.Show citation box Response: We appreciate the suggestion that morbid obesity multiple co-morbidities be a complete, inclusive list and will consider it as one of many recommendations in revising the benefit policy. We disagree with the commenter's suggestion that vertical sleeve gastrectomy (VSG) and biliopancreatic diversion with duodenal switch (BPD/DS) should be covered under the TRICARE Program. The evidence evaluating the safety and efficacy of BPD/DS and VSG do not meet the program specific standards of reliable evidence. Existing data does suggest the use of these procedures is a possible benefit to some patients but there is incomplete information to predict the effect of long-term outcomes. This lack of information relating to the long-term outcomes is a matter of concern to the Department. Medical literature indicates as well that well-controlled trials are needed to determine both short-term and long-term safety and efficacy of BPD/DS and long-term (> 5 years) weight loss and co-morbidity resolution data for VSG. The Agency will continue to monitor the development of the literature and the status of ongoing well-controlled clinical trials regarding the effectiveness of the laparoscopic VSG and BPD/DS procedures. At such time when the reliable evidence demonstrates that these bariatric surgical procedures have proven medical effectiveness, the Director, TMA will initiate action to cover these procedures." I have placed a call to Ms. Gail Jones, who is the contact person for this information. She was not in, but I left a message for her to call me back. When I get anything definitive regarding the possible coverage of VSG, I will post it here.

Have u had a recent xray? 3 yrs of a lapband, almost daily vomiting, I suffered severe nighttime reflux. My band had slipped. gained 30 lbs back during the year I was unfilled. Last July I had a sleeve revision. Sometimes reflux is the ONLY symptom of a slip. I had a minor slip that turned into a major slip and couldn't be fixed on it's own. Good luck! I know how miserable reflux is.

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.

Usually the reason sleeve patients get revisions to bypass is because they end up having very bad acid reflux.... daily.

I have been unfilled for the past few weeks, and I miss it. The band made every bite hurt, but I wasn't hungry. My DH says he is going to knock me in the head. I have until next weekend to decide if I am going to do the RnY, and I am scared. I don't want to do it. I have heard all kinds of horrible stories about it, and I don't want to die, wear carbon filters in my underwear, or never eat sweets again (in any amount). A coworker had it done a few months ago and she looks great, losing 70lbs in 4 months, but what if it does not work for me? You can't just revise that one, remove the device, or go back. My hubby says that if the insurance will pay for it, that means I am screwed anyway, so I need to do it. (We have BC/BS, so he is right, they don't pay for anything.) My PCP says the same thing, and she wants me to do it. I emailed Dr. C and he said that he would remove it and convert. If it is in the wrong place it can do damage even unfilled. I feel like such a failure. Please tell me again, if it were you, what would you do? I know you can't tell me what to do, but I want to know your honest opinions. You have been going thru the same fight the past year as I have, but if you were told what I have been told what would you think/do?

I'm March 8th with Dr. Aceves in Mexico! Revision from band to sleeve! Super excited and a tad nervous! Wish it was now!!

I would look in several places for information...on this forum read throught the posts under lap band to sleeve revisions. Read Sleeve success stories. Also search for post about would you do it again on this forum to get the pros and cons of sleeve. Then go to the Lap Band forum and read the success stories, but also search for posts for the struggles people are having. I would look at success rates, weight loss totals, long term weight loss maintenance and complications. Finally I would ask your surgeon. My two cents. I was planning on getting the lap band. Several reasons I chose sleeve instead: 1. better overall percentage of weight loss with sleeve vs band 2. faster weight loss with sleeve vs band 3. no maintenence (fills, unfills etc.) on sleeve 4. no foreign device in my body that could errode, slip or cause other complications. I am 11 years older than you and had starting weight of 272 at 5'9". I had no health issues other than mild sleep apnea and being overweight. I am glad I made the choice I did.

I have an old 4 mm band, and am researching removal and revision to the sleeve. I was banded 5/2005 - I lost 60 pounds relatively easily, bit then started infertility treatments and after two miscarriages and two,successful pregnancies, I am right back where I started. I can't eat foods that are good for me, and I can too easily cheat the band....hoping the sleeve will give me a new shot to get this weight off once and for all!

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:

Good luck to you. After my endoscope my surgeon told me I'm not a candidate for sleeve because it would increase my gerd. Since then I have read so much about folks having terrible gerd and going for revisions. This confirms my decision to move forward with bypass. I wish you luck and a speedy recovery.

I used two different Plastic Surgeons in TJ, one I wasn't that thrilled with. His name was Dr Q and he did a really sloppy job on my breast and my arms....BUT then I started to see incrediable pictures of beautiful work, from another TJ plastic surgeon, (And really isn't that what it's all about?) The most affordable outstanding work possible My new surgeon who did a lower body lift, gave me those results, Dr Victor Gutierrez also in TJ. For me it was a no brainer, he does all internal stiching, so you don't have to spend any longer than one week and it's just 5 mins across the border, they pick you up at the airport and return you there when it's time to go home....I have pictures posted on my page here at just two weeks out from surgery. I am planning on going back down to have some revisions done from the first surgery I had with that other surgeon...Dr Gutierrez will be correcting those...

Thanks, DiBaby! And good for you getting back to spin class! I was all ready to sign up when I realized the class was only one night a week...is that typical?!?!? I'm taking Fish Oil, yes. They are huge, yes. But nothing compared to the CLA I am taking! Gels go down fine for me, no matter how large, thank goodness. The pills just kill me. I am also using Creatine, Glutamine, RedLine, B6, L-Carnitine, Flaxseed, and ZMA. I will tell you what I believe about Protein if no one kills the messenger! When I discussed it on another thread, I felt I was gonna be lynched. But this IS an excercise thread, so I should be safe, right? LOL First of all, that's bull-puckey about only being able to absorb ANY specified amount of protein and expect that to apply to the masses. The amount of protein you can take in at any given time depends on your body weight, your current level of excercise, if you consume it immediately before or after your workout, what KIND of protein you are consuming, etcetera. Example, my smoothie has already "grown up" in just a week and now contains 70 grams of protein. But I only get it immediately after a workout. That is simply preference, as you could/should load up either an hour before or immediately following a workout. I use whey protein during the day, as it is utilized generally within two hours. I use casein protein immediately before bed because it is slow release and lasts up to seven hours while I sleep. How much protein you should consume in a day depends on your goals, but a general rule-of-thumb is minimum one gram of protein for each pound of body weight. That should increase to minimum one and a half grams if you are trying to add muscle mass. My goal is a blend of first body fat percentage reduction and second adding muscle mass, and I go with the one and a half grams per pound of body weight. This is a brand new revised goal for me, based on research through tons of reading and talking with trainers and the folks at The Vitamin Shoppe and Max Muscle. I didn't revise the amount of protein I shoot for, but revised how much and how often I need to eat...meaning I need to eat tons more frequently, resulting in eating a lot more over the course of a day. I just can't keep at the ultra-low calorie intake I've been on since June and get all this protein in, so calorie counting went out the window for me. I finally realized that I work out WAY too much to be concerned with how many calories I'm taking in. I was constantly trying to hit my protein goal and stay under my calorie goal, and it just wasn't working for me anymore. It took a lot of research to convince me, though! We will see if I made the right decision soon enough. You should go get this months' copy of the magazine that The Vitamin Shoppe puts out, "Muscle & Body"...fantastic info. I don't know a flippin' thing about the glycemic index stuff yet. Keep us posted!

Oni, I am so sorry to hear of your troubles. I had the horrible lap band for about 1 1/2 years. It nearly killed me. I had some problems similar to yours. My body did not tolerate the band. Adhesions formed wherever the band/components touched. Even had adhesions under the band that nearly closed my stomach off completely. My original surgeon wouldn't listen to me. Even told me that I should be happy with the 85 lb weight loss. Didn't seem to care that I needed I.V. infusions nearly every other day. The original surgeon always did the band fills without fluoroscopy so he never even noticed the issues. Many times, with the first swallow of anything, even warm Water, I would have projectile puking episodes. Of course, the original surgeon tried to blame me for taking too big of bites (how could I take too big of bites of water?!!!). Well, to make a long story short, I found another surgeon. Firstly, the band isn't always reversable. Mine did irreversable damage. Secondly, they have been doing partial gastrectomies for many, many years. I felt extremely comfortable with the decision to be "sleeved". I am so glad I revised. I now have my life back. I went to one of the best revision surgeons in another country (even though my insurance would have paid to have the sleeve done in the U.S.). He LISTENED to me and made the diagnosis pretty much immediately. Took him almost 3 times longer than normal to do my revision due to all the damage the band had done to me internally. Basically, just find an excellent revsion surgeon and get rid of that killer lap and. It will be the best thing you will ever do for yourself. I absolutely have no problems now. The sleeve rocks. I feel like a normal person now. Can eat small amounts of anything I want. Never have to worry about puking (I remember the nightmare days of carrying plastic Walmart bags around to puke in at a moments notice, travelling with plastic cups in my car and puking while driving down the road, etc). Good luck in what ever you decide. Millie

21 - WOW thats a lot of issues for someone so young. I pray that everything goes well with the revision Beckyy93! Your story is exactly what I am afraid of!

Slindownthick I am glad your revision went great congrats, I can't wait to join you.