American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Successful Surgical Coding

Who Should Attend This Course

General Surgeons

Getting paid is a team effort—and surgeons lead the team. If the doctors don't understand what's needed in an operative report from a coding and reimbursement point of view (something they don't teach in residency) they are shortchanging themselves.

Practice Administrators and Managers

You are the chief compliance officer in most private practices. In order to supervise the economic engine of the practice, you must understand the business office operations.

Coders and Billers

If you're responsible for entering data, working denials, applying modifiers, posting payments, and filing appeals, your expertise in surgical and office coding must be exacting in its execution!

Hospital or MSO Executives Running General Surgery Practices

Maximize your profits! Understand what is special and unique about billing for the general surgery service line, and keep your surgeons happy and bonus-able. (Not to mention reduce compliance headaches.) Learn the rules and avoid using incorrect and expensive assumptions that result in fiscal disaster.

Register now!

Learning Objectives

As a result of this course, participants will be able to:

  • Distinguish different categories of codes and how payment differs
  • Describe what is included in a global surgical package and what can be reported separately
  • Distinguish what surgical modifier to report
  • Describe documentation requirements for unlisted codes
  • Demonstrate correct coding and documentation for radiology services
  • Describe coding for different surgical approaches
  • Identify when to report mesh and reinforcement implants
  • Demonstrate correct coding for a variety of general surgery procedures

What's on the Agenda

Definition Kick-off

  • The basics: defining coding vs. reimbursement
  • Types of codes: primary, add-on, Category III
  • What is a "separate procedure" per CPT?

The Global Surgical Package

  • What's included in the global package and what can be separately reported?
  • Deconstructing the global payment: surgical splits, RVUs, and physician time

Surgeon Role Modifiers

  • Co-Surgery vs. Assistant: Are you reporting these correctly?
  • Payor expectations for co-surgery and assistant surgery documentation.
  • Reimbursement: Difference between co-surgeon and assistant surgeon

Same-Day Procedure Modifiers

  • Modifier 22: What justifies modifier 22 and how to increase your changes of payment?
  • Modifier 50: Which procedures accept a bilateral modifier?
  • Modifier 52 vs. 53: What is the difference and how are they used in general surgery?
  • Modifier 51 vs. 59: How do you know which one to use? How does reimbursement differ for each?

Modifiers for Additional Procedures Performed during the Global Surgical Period

  • Modifier 58: Documenting staged procedures: Do they always need to be preplanned? What about repeating a resection after pathology shows more margins?
  • Modifier 79: What defines an unrelated procedure? Is a different diagnosis essential?
  • Modifier 78: Does this apply to in-office procedures? How do I report in-office treatment of postoperative complications?

Revenue Optimization; Charge Entry Tips of the Trade

Strategic Appeals; Charge Entry Tips of the Trade

Documentation for Unlisted Procedures

  • How to report and get paid
  • Template letter for reporting unlisted codes
  • Case scenarios

Radiology Coding and Documentation for Surgeons

  • Fluoroscopy and ultrasound: Is a separate report required? What about intraoperative imaging?
  • Documenting imaging with central lines: fluoroscopy, ultrasound, or both?

Surgical Approaches and Code Selection: Percutaneous vs. Open vs. Laparoscopic—Does It Matter?

Coding for Robotic Assistance

  • Using the HCPCS code
  • Setting a fee and getting paid
  • Operative note documentation best practice op note dformat
  • Documentation to optimize coding accuracy and revenue

Hernia Surgery

  • Hiatal/paraesophageal hernias: Type 1, 2, 3, 4
  • Open/laparoscopic hernia repair
  • Reporting mother procedures with hernia codes—CPT rules vs. payor realities
  • Reporting mesh placement
  • Reporting mesh removal; infected and non-infected mesh
  • Component separation release/abdominal reconstruction
  • Case scenarios

Abdominal Reconstruction/Component Separation

  • Documentation imperatives
  • Myocutaneous flaps vs. Rives Stoppa

All About Implants

  • Biological vs. non-biological: Knowing which to report

Endoscopy Overview

  • General concepts in endoscopy coding: Completion endoscopy—billable or not?
  • Moderate sedation: Are you documenting enough?
  • Upper GI endoscopy overview
  • Colonoscopy—Sigmoidoscopy vs. colonoscopy: How far is far enough?
  • Case scenarios

Colorectal Surgery

  • Approach matters: Laparoscopic vs. open
  • What's the difference between colostomy and coloproctostomy? A sigmoid colectomy and a low-pelvic anastomosis?
  • Total and subtotal colectomy: Is there a difference?
  • Stoma creation, revision, and closure
  • Case scenarios

Appendix Surgery

  • Lap vs. open
  • Laparoscopic repair of a rupture appendix
  • Case scenarios

Gallbladder and Liver Surgery

  • Cholecystectomy: When can a cholangiogram be separately reported?
  • Liver biopsy: Percutaneous vs. open
  • Liver resections: How many hepatectomies (47120) are too many?
  • Case scenarios

Breast Procedures

  • New guidelines for mastectomy procedure coding
  • Breast biopsy: Percutaneous, incisional, and excisional
  • Sentinel node mapping and excision
  • Lymph node dissection: How does this change coding?
  • Mastectomy coding: Lumpectomy, simple and radical mastectomies
  • Reporting closures and local advancement flaps
  • Can placement of a marker in a lumpectomy cavity be reported?
  • Case scenarios

Pancreatic Resection

  • Whipple procedures
  • Other pancreatic resections
  • Intra-abdominal vein reconstruction in abdominal procedures

Intra-Abdominal Lesion Codes

  • What can be separately reported?
  • Coding HIPEC and getting paid?

Endocrine Surgery

  • Thyroid
  • Parathyroid
  • Adrenal