Catechesis in the Church's mission of evangelization "Go into all the world; and preach the Gospel to the whole creation" Mk The missionary mandate of Jesus
Weight-related arthropathies that impair physical activity; or Obesity-related psychosocial distress. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program including dietician consultation, low calorie diet, increased physical activity, and behavioral modificationdocumented in the medical record at each visit.
This physician-supervised nutrition and exercise program must meet all of the following criteria Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation.
The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. A physician's summary letter is not sufficient documentation.
Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program e. Behavior modification program supervised by qualified professional; and Consultation with a dietician or nutritionist; and Documentation in the medical record of the member's participation in the multi-disciplinary surgical preparatory regimen at each visit.
Records must document compliance with the program; the member must not have a net gain in weight during the program. A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multi-disciplinary surgical preparatory regimen.
The presence of depression due to obesity is not normally considered a contraindication to obesity surgery.
Vertical Banded Gastroplasty VBG Aetna considers open or laparoscopic vertical banded gastroplasty VBG medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following co-morbid medical conditions: Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or Hepatic cirrhosis with elevated liver function tests; or Inflammatory bowel disease Crohn's disease or ulcerative colitis ; or Poorly controlled systemic disease American Society of Anesthesiology ASA Class IV see Appendix ; or Radiation enteritis.
Aetna considers VBG experimental and investigational when medical necessity criteria are not met. Repeat Bariatric Surgery Aetna considers removal of a gastric band medically necessary when recommended by the member's physician.
Aetna considers surgery to correct complications from bariatric surgery medically necessary, such as obstruction, stricture, erosion, or band slippage.
Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary i. Experimental and Investigational Bariatric Surgical Procedures Aetna considers each of the following procedures experimental and investigational because the peer-reviewed medical literature shows them to be either unsafe or inadequately studied: Gastrointestinal liners endoscopic duodenal-jejunal bypass, endoscopic gastrointestinal bypass devices; e.
Background These criteria were adapted from the NIH Consensus Conference on Surgical Treatment of Morbid Obesity which state that obesity surgery should be reserved only for patients who have first attempted medical therapy: Therefore, the appropriateness of obesity surgery in non-compliant patients should be questioned.
The patient must be committed to the appropriate work-up for the procedure and for continuing long-term post-operative medical management, and must understand and be adequately prepared for the potential complications of the procedure.
There is rarely a good reason why obese patients even super obese patients can not delay surgery in order to undergo behavioral modification to improve their dietary and exercise habits in order to reduce surgical risks and improve surgical outcomes. The patient may be able to lose significant weight prior to surgery in order to improve the outcome of surgery.
Obesity makes many types of surgery more technically difficult to perform and hazardous. Weight loss prior to surgery makes the procedure easier to perform.
Weight reduction reduces the size of the liver, making surgical access to the stomach easier. By contrast, the liver enlarges and becomes increasingly infiltrated with fat when weight is gained prior to surgery.
A fatty liver is heavy, brittle, and more likely to suffer injury during surgery. Moreover, following surgery, patients have to follow a careful diet of nutritious, high-fiber foods in order to avoid nutritional deficiencies, dumping syndrome, and other complications.
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