UM Guidelines
Gastric Restrictive Procedure without Gastric Bypass by Laparoscopy

Inpatient and Surgical Care (ISC)

BCBST last reviewed May 9, 2024*

Added to Clinical Indications:
   
Procedure is indicated for ...
 
 
  • Severity of obesity judged appropriate for procedure as indicated by...
  • Patient is candidate for bariatric surgery as indicated by...
    • ...
    • Patient is receiving treatment in multidisciplinary program that can provide...
      • ...
      • Preoperative medical consultation [and approval from primary care physician, nurse practitioner or physician assistant]*
      • ...
   

References

American Association Of Clinical Endocrinologist, American College Of Endocrinology, The Obesity Society, American Society For Metabolic & Bariatric Surgery, Obesity Medicine Association, American Society Of Anesthesiologist. (2019, December). 2019 Guidelines. AACE/TOS/ASMBS/OMA/ASA clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures. Retrieved March 17, 2020 from https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406.

BlueCross BlueShield of Tennessee network physicians. April - May 2024.

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