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Coding and Coverage of Bariatric Procedures


Getting paid for open and laparoscopic bariatric procedures requires that surgeons code correctly and follow the right guidelines. For example, what can be billed in addition to the bariatric procedure? Is hernia repair separately reported? And if so, with which codes, and will a modifier be necessary?

Equally as important is understanding coverage policies. Medicare has a national coverage policy that is implemented at the discretion of local Medicare carriers. Private payors have their own coverage criteria that must be met before reimbursement will be authorized. Bariatric surgeons must be familiar with payor-specific policies and ensure that all patients comply with requirements.

This fast-paced, 20-minute program addresses both topics and covers:

  • Coding for bariatric procedures: open and laparoscopic.
  • Coding for hiatal hernia repair with a bariatric procedure: When is it appropriate? Which codes should be used? Will it get paid?
  • Coding for gastric band adjustment during and after the global period.
  • Medicare coverage for bariatric procedures. What does Medicare consider medically necessary (and reimbursable) for bariatric procedures?
  • Private payor coverage for bariatric procedures. How and where do you find coverage policies for your top private payors? What are they likely to include?

Teri Romano, BSN, MBA, CPC, CMDP

Speaker and Consultant

KarenZupko & Associates, Inc.

Teri Romano has over twenty-five years of consulting and teaching experience in the health care field. Ms. Romano works with physician groups and hospitals combining a background in clinical systems with solid approaches to operational and organizational problem solving.

Find out about more about Teri Romano, RN, MBA, CPC, CMDP


Coding and Coverage of Bariatric Procedures
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Open to view video.
Coding and Coverage of Bariatric Procedures - Handout
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Open to download resource.
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