(Medicare Claims Processing Manual)

0D168ZB  Bypass Stomach to Ileum, Via Natural or Artificial Opening Endoscopic   0D168ZL    0DV64CZ   Bypass Stomach to Transverse Colon, Via Natural or Artificial Opening  Endoscopic     Restriction of Stomach with Extraluminal Device, Percutaneous                              Endoscopic Approach    To describe either laparoscopic or open BPD with DS or GRDS, one code from each of the following three groups must be on the claim:   Group 1:  0DB60Z3 Excision of Stomach, Open Approach, Vertical  0DB60ZZ  Excision of Stomach, Open Approach  0DB63Z3 Excision of Stomach, Percutaneous Approach, Vertical  0DB63ZZ  Excision of Stomach, Percutaneous Approach  0DB67Z3 Excision of Stomach, Via Natural or Artificial Opening, Vertical  0DB67ZZ      Excision of Stomach, Via Natural or Artificial Opening  0DB68Z3 Excision of Stomach, Via Natural or Artificial Opening Endoscopic, Vertical    Group 2:  (Note: One code from A -C below is required for a correct equivalent)     0DB80ZZ  Excision of Small Intestine, Open Approach  A    0DB90ZZ  Excision of Duodenum, Open Approach  A    0DBB0ZZ  Excision of Ileum, Open Approach  A   0D160ZB  Bypass Stomach to Ileum, Open Approach  B    0F190Z3  Bypass Common Bile Duct to Duodenum, Open Approach  C   Group 3:   0D19079  Bypass Duodenum to Duodenum with Autologous Tissue Substitute,  Open Approach   0D1907A   Bypass Duodenum to Jejunum with Autologous Tissue Substitute, Open Approach   0D1907B   Bypass Duodenum to Ileum with Autologous Tissue Substitute, Open Approach   0D190J9  Bypass Duodenum to Duodenum with Synthetic Substitute, Open Approach  0D190JA  Bypass Duodenum to Jejunum with Synthetic Substitute, Open Approach  0D190JB  Bypass Duodenum to Ileum with Synthetic Substitute, Open Approach   0D190K9  Bypass Duodenum to Duodenum with Non- autologous Tissue Substitute,  Open Approach   0D190KA   Bypass Duodenum to Jejunum with Non- autologous Tissue Substitute,  Open Approach   0D190KB   Bypass Duodenum to Ileum with Non- autologous Tissue Substitute, Open Approach  0D190Z9   Bypass Duodenum to Duodenum, Open Approach  0D190ZA  Bypass Duodenum to Jejunum, Open Approach   0D190ZB   Bypass Duodenum to Ileum, Open Approach   0D19479  Bypass Duodenum to Duodenum with Autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1947A   Bypass Duodenum to Jejunum with Autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1947B   Bypass Duodenum to Ileum with Autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D194J9  Bypass Duodenum to Duodenum with Synthetic Substitute, Percutaneous  Endoscopic Approach   0D194JA   Bypass Duodenum to Jejunum with Synthetic Substitute, Percutaneous  Endoscopic Approach   0D194JB   Bypass Duodenum to Ileum with Synthetic Substitute, Percutaneous  Endoscopic Approach   0D194K9  Bypass Duodenum to Duodenum with Non- autologous Tissue Substitute,  Percutaneous Endoscopic Approach     0D194KA  Bypass Duodenum to Jejunum with Non -autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D194KB   Bypass Duodenum to Ileum with Non- autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D194Z9   Bypass Duodenum to Duodenum, Percutaneous Endoscopic Approach   0D194ZA   Bypass Duodenum to Jejunum, Percutaneous Endoscopic Approach   0D194ZB   Bypass Duodenum to Ileum, Percutaneous Endoscopic Approach   0D19879  Bypass Duodenum to Duodenum with Autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D1987A   Bypass Duodenum to Jejunum with Autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D1987B   Bypass Duodenum to Ileum with Autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D198J9  Bypass Duodenum to Duodenum with Synthetic Substitute, Via Natural  or Artificial Opening Endoscopic   0D198JA   Bypass Duodenum to Jejunum with Synthetic Substitute, Via Natural or  Artificial Opening Endoscopic   0D198JB   Bypass Duodenum to Ileum with Synthetic Substitute, Via Natural or  Artificial Opening Endoscopic   0D198K9  Bypass Duodenum to Duodenum with Non- autologous Tissue Substitute,  Via Natural or Artificial Opening Endoscopic   0D198KA   Bypass Duodenum to Jejunum with Non- autologous Tissue Substitute,  Via Natural or Artificial Opening Endoscopic   0D198KB   Bypass Duodenum to Ileum with Non- autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D198Z9  Bypass Duodenum to Duodenum, Via Natural or Artificial Opening  Endoscopic   0D198ZA   Bypass Duodenum to Jejunum, Via Natural or Artificial Opening  Endoscopic   0D198ZB   Bypass Duodenum to Ileum, Via Natural or Artificial Opening  Endoscopic   0D1A07A   Bypass Jejunum to Jejunum with Autologous Tissue Substitute, Open Approach   0D1A07B   Bypass Jejunum to Ileum with Autologous Tissue Substitute, Open Approach  0D1A0JA  Bypass Jejunum to Jejunum with Synthetic Substitute, Open Approach   0D1A0JB   Bypass Jejunum to Ileum with Synthetic Substitute, Open Approach    0D1A0KA    Bypass Jejunum to Jejunum with Non- autologous Tissue Substitute, Open Approach   0D1A0KB   Bypass Jejunum to Ileum with Non- autologous Tissue Substitute, Open Approach  0D1A0ZA  Bypass Jejunum to Jejunum, Open Approach   0D1A0ZB    Bypass Jejunum to Ileum, Open Approach   0D1A47A   Bypass Jejunum to Jejunum with Autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1A47B   Bypass Jejunum to Ileum with Autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1A4JA   Bypass Jejunum to Jejunum with Synthetic Substitute, Percutaneous  Endoscopic Approach   0D1A4JB   Bypass Jejunum to Ileum with Synthetic Substitute, Percutaneous  Endoscopic Approach   0D1A4KA   Bypass Jejunum to Jejunum with Non- autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1A4KB   Bypass Jejunum to Ileum with Non- autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1A4ZA    Bypass Jejunum to Jejunum, Percutaneous Endoscopic Approach   0D1A4ZB   Bypass Jejunum to Ileum, Percutaneous Endoscopic Approach   0D1A87A   Bypass Jejunum to Jejunum with Autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D1A87B   Bypass Jejunum to Ileum with Autologous Tissue Substitute, Via Natural  or Artificial Opening Endoscopic   0D1A8JA   Bypass Jejunum to Jejunum with Synthetic Substitute, Via Natural or  Artificial Opening Endoscopic   0D1A8JB   Bypass Jejunum to Ileum with Synthetic Substitute, Via Natural or  Artificial Opening Endoscopic   0D1A8KA   Bypass Jejunum to Jejunum with Non- autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D1A8KB   Bypass Jejunum to Ileum with Non- autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D1A8ZA   Bypass Jejunum to Jejunum, Via Natural or Artificial Opening  Endoscopic  0D1A8ZB  Bypass Jejunum to Ileum, Via Natural or Artificial Opening Endoscopic   0D1A8ZH   Bypass Jejunum to Cecum, Via Natural or Artificial Opening Endoscopic   0D1B07B   Bypass Ileum to Ileum with Autologous Tissue Substitute, Open Approach  0D1B0JB  Bypass Ileum to Ileum with Synthetic Substitute, Open Approach   0D1B0KB   Bypass Ileum to Ileum with Non -autologous Tissue Substitute, Open Approach   0D1B0ZB   Bypass Ileum to Ileum, Open Approach   0D1B47B   Bypass Ileum to Ileum with Autologous Tissue Substitute, Percutaneous  Endoscopic Approach   0D1B4JB   Bypass Ileum to Ileum with Synthetic Substitute, Percutaneous  Endoscopic Approach   0D1B4KB   Bypass Ileum to Ileum with Non- autologous Tissue Substitute,  Percutaneous Endoscopic Approach   0D1B4ZB   Bypass Ileum to Ileum, Percutaneous Endoscopic Approach   0D1B87B   Bypass Ileum to Ileum with Autologous Tissue Substitute, Via Natural or  Artificial Opening Endoscopic   0D1B8JB   Bypass Ileum to Ileum with Synthetic Substitute, Via Natural or Artificial  Opening Endoscopic  0D1B8KB  Bypass Ileum to Ileum with Non-autologous Tissue Substitute, Via  Natural or Artificial Opening Endoscopic   0D1B8ZB   Bypass Ileum to Ileum, Via Natural or Artificial Opening Endoscopic   0D1B8ZH   Bypass Ileum to Cecum, Via Natural or Artificial Opening Endoscopic   NOTE: There is no distinction between open and laparoscopic BPD with DS or GRDS for the inpatient setting. For either approach, one code from each of the above three groups must appear on the claim to be covered.   Effective October 1, 2015, the following ICD-10 procedure code is covered for bariatric surgery at contractor discretion:  0DB64Z3 Excision of stomach, percutaneous endoscopic approach, vertical.  150.4 - ICD Diagnosis Codes for Bariatric Surgery  (Rev. 11021; Issued: 10-01- 21; Effective: 10 -29-21; Implementation: 10 -29-21)  For services on or after October 1, 2015, the following ICD-10 diagnosis code is  covered for bariatric surgery if certain other conditions are met:  E66.01 - Morbid (severe) obesity due to excess calories  Effective for services performed on and after February 12, 2009, type 2 diabetes mellitus (T2DM) is considered a comorbid condition related to morbid obesity for covered bariatric surgery procedures in Medicare beneficiaries with a BMI 35. When T2DM is the comorbid condition related to morbid obesity, the claim must include a covered ICD procedure code, ICD diagnosis code E66.01 as a primary diagnosis, a covered ICD diagnosis code indicating T2DM as a secondary diagnosis, and an ICD diagnosis code indicating a BMI  35 as a secondary diagnosis.   150.5 - ICD Diagnosis Codes for BMI 35 (Rev. 11021; Issued: 10-01- 21; Effective: 10 -29-21; Implementation: 10-29-21)  The following ICD- 10 diagnosis codes identify BMI 35: