Coding and Reimbursement for Bariatric Surgery

Abstract

The American health-care system has a system for assigning value for care services delivered. While health-care providers have historically worked on a fee-for-service basis, there was a need for standardization of cost per level of service. The process of assigning a Current Procedural Terminology (CPT) code and the associated valuation for a given service is at the core of the reimbursement process. This chapter reviews the basics of the CPT and Relative Value Update Committee (RUC) process and methodology to understand why and how a code is created and assigned a value. We will also look at the roles of CMS and private payers in determining coverage for procedures and assigning actual reimbursement. Lastly, we will address the challenges of provider and hospital reimbursement in a field as rapidly developing as Bariatric surgery.