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Bariatric Surgery Checklist

Date: 11/17/23

Fort Lauderdale, Florida

Sunshine Health requires providers to complete a preoperative evaluation before it can evaluate bariatric surgery requests.

To help providers, we’ve put together a checklist of the required records, evaluations and test results for the patients under their care. These records must be submitted six months in advance.

Failure to turn in all the required documentation may result in a denial or a request to submit the missing records.

Preoperative Evaluation Checklist

  • Low Cardiac Risk: Patient must be cleared by their Primary Care Physician (PCP) or cardiologist.
    • Clearance document must be submitted with request.
  • High Cardiac Risk: Patient must be cleared by their cardiologist and undergo an electrocardiogram (ECG).
    • Clearance document must be submitted with request.
  • Blood Work: Hgb A1C and Fasting Blood Glucose tests are required.
  • Sleep Apnea: Patient must be screened for obstructive sleep apnea.
  • Pulmonary Function Test (PFT): Required if patient has a history of lung disease or sleep disordered breathing.
  • Arterial Blood Gas (ABG) Test: Required if patient has a history of lung disease or sleep disordered breathing.
  • Nutrition Evaluation: Patient’s B-12, folic acid, iron and vitamin D levels must be tested.
    • Insufficiencies/deficiencies must be treated prior to surgery.
  • Nutritional Therapy and Counseling: Comprehensive diet history must be provided.
    • Patient must have an assessment of current nutrition/exercise/steps patterns.
    • Patient must modify problem eating behavior.
    • Patient must undergo monthly nutritional counseling until surgery.
    • Documentation is required that counseling was conducted regarding potential for success of weight loss surgery dependent on post-op diet modification.
  • Psychiatry/Psychology Evaluation
  • TSH (Thyroid-Stimulating Hormone) Test: Patients must undergo treatment if hypothyroidism is suspected or present.
  • Fasting Lipid Panel: Patient must undergo treatment if diagnosed with dyslipidemia.
  • UGI (Upper Gastrointestinal Series)/Endoscopy: Must be performed if gastrointestinal symptoms present.
    • Must be treated prior to bariatric surgery.
  • Helicobacter pylori (H. pylori) Infection: Patient must be tested if symptoms of ulcer disease present.
    • Documentation of treatment must be included if patient tests positive.
  • Gout: Must be treated if patient is diagnosed.
  • Smoking cessation: Patient must quit smoking at least six weeks prior to surgery.

Questions?

If you have questions, please contact your Provider Engagement Administrator. You can also call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Stay up to date on Sunshine Health provider notices by reviewing and bookmarking Provider News.

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