Prior authorization for bariatric surgery
Bariatric surgery requests are usually the longest file a clinic assembles. Reviewers expect a documented weight history, qualifying comorbidities, evidence of structured non-surgical treatment and assessments from several disciplines. The letter's job is to pull those pieces into one account that a reviewer can check item by item.
The components reviewers check
- Current measured weight, height and body mass index, and the weight history over the preceding period, since many criteria look for a sustained body mass index rather than a single reading.
- Obesity-related conditions with their current status: type 2 diabetes with HbA1c, hypertension, obstructive sleep apnoea, fatty liver disease, osteoarthritis of weight-bearing joints.
- Structured weight management attempts: supervised programmes, dietitian input, medication, with dates and outcome.
- Nutritional assessment by a dietitian.
- Psychological or psychiatric evaluation confirming readiness and addressing eating disorders or substance use.
- Medical optimisation: smoking status, sleep apnoea treatment, glycaemic control.
- The planned procedure and the patient's understanding of lifelong supplements and follow-up.
How to order the letter
- Procedure and codes. For example laparoscopic sleeve gastrectomy (43775), with the obesity code and the matching body mass index code.
- Weight history. Current values, then the trend with dates.
- Comorbidities. Each condition with its current control and treatment.
- Non-surgical treatment. What was done, who supervised it, how long and the result.
- Assessments. Dietitian, psychology, medical and, where relevant, cardiology or respiratory clearance, with dates.
- Rationale. Why surgery is the appropriate next step for this patient now.
Example
Request: Laparoscopic sleeve gastrectomy (43775). Diagnoses: Morbid (severe) obesity due to excess calories (E66.01); body mass index 40.0-44.9, adult (Z68.41); type 2 diabetes mellitus without complications (E11.9); obstructive sleep apnoea (G47.33); essential hypertension (I10). [Patient initials], 42. Weight 124 kg, height 1.72 m, BMI 41.9 today. BMI has been above 40 at each clinic visit over the past 3 years. Non-surgical treatment: 9-month dietitian-led programme with monthly visits, 6 kg lost and regained within a year. A weight management medicine was used for 7 months with 5% loss, stopped because of persistent vomiting. Comorbidities: HbA1c 7.6% on metformin; sleep apnoea on CPAP with good adherence; blood pressure controlled on two agents. Assessments: dietitian and psychological evaluations completed this quarter, both supporting surgery; non-smoker.
Frequent reasons for refusal
The pattern is consistent. A single body mass index reading where a history is needed; a weight management attempt described as 'has tried dieting' without supervision, duration or outcome; a missing psychological evaluation; or an uncontrolled comorbidity with no plan to optimise it before surgery. Each can be fixed by adding the dated fact to the note and the letter.
When the programme duration falls short of the criteria, the letter should not stretch it. The honest route is to continue the programme and resubmit when the requirement is met.
What ClearPass does here
ClearPass drafts the bariatric justification from the clinic note and any reports you photograph into it, with ICD-10 and procedure codes, in Concise, Standard or Detailed length. It pulls dates and values from the note into the order above and lists anything a reviewer would expect that it cannot find, such as the psychological evaluation date. Outside the one country with a rules pack, it makes the clinical case without quoting any payer's programme requirements. You review and send it. For the related medicine request see GLP-1 prior authorization.
What ClearPass does not do
- It does not replace your judgement. Every note is an AI draft that you review and correct before it is used.
- It is not a medical device and does not make clinical decisions. It is a documentation aid.
- It does not connect to your EMR. The note is copy-ready text that pastes into any system.
Privacy
Clinical note content is not stored on ClearPass servers: it is processed to write the note, then discarded. Consultation audio is transcribed and discarded, never stored. Your note history stays in your browser, on your device, and you choose how long it is kept. Common identifiers are removed from typed and transcribed text before it reaches the AI; that is a best-effort safeguard, so leave names, ID numbers and file numbers out where you can. Processing goes through the AI providers named in our Privacy Policy, which sets out exactly what each one receives and how long it keeps it. ClearPass does not sign HIPAA business associate agreements today.
Questions
Can one letter cover all the assessments?
Yes, if the results are in the note or pasted in. Many teams keep each assessment as a separate document; the letter summarises them with dates so the reviewer can match the attachments.
Which body mass index code should I use?
The Z68 code that matches the measured value on the day, for adults. It supports, and does not replace, the obesity diagnosis code.
Does ClearPass decide if the patient qualifies?
No. It drafts the case from the documented facts and points out gaps. Whether surgery is appropriate is your decision and the multidisciplinary team's.
Does the letter need to name the surgical team?
Where criteria ask for assessment by a multidisciplinary programme, state which disciplines saw the patient and when. The letter does not need staff names; dates and outcomes are what the reviewer checks.
What does ClearPass cost?
The 7-day trial is free, needs no card and simply ends after 7 days, with no automatic charge. After that there is one plan: $78 a month or $858 a year, with every visit transcribed.
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