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

Challenges in General Surgery Coding and Reimbursement

Who Should Attend This Course

Practice Executives, Administrators, and Practice 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.

Team Attendance Produces the Best Results!
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 short changing themselves.

Learning Objectives

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

  • Effectively incorporate 2015 CPT code changes and guidelines into practice.
  • Describe how CPT rules and Medicare rules differ and how this impacts coding and billing.
  • Define modifiers—how they are used and how they impact reimbursement.
  • Identify coding guidelines for the most common procedures performed by general surgeons.

What’s on the Agenda

The Global Surgical Package

  • What's included and what's separately reported?
  • Proposed Medicare changes and how they will impact reimbursement
  • Reporting radiology services when not included in the surgical code

Surgeon Role Modifiers

  • Co-surgery vs. assistant: Are you reporting these correctly?

Same Day Surgical Procedure Modifiers

  • Modifier 22: When is it appropriate to use a 22 and will it get paid?
  • Modifiers 50: Which procedures accept a bilateral modifier?
  • Modifiers 52 vs. 53: What's the difference and how are they used in general surgery?
  • Modifier 51 vs. 59: How do you know which one to use?
  • Understanding Medicare's proposed changes to Modifier 59

Surgical Services Performed During the Global Surgical Period

  • Modifiers 58, 78, and 79: What are they and how do they impact reimbursement?

Central Venous Catheter Basics

  • Coding alone and with other procedures
  • Image guidance coding with central lines

2015 Breast Coding

  • Breast biopsy: Open and percutaneous
  • Sentinel lymph node mapping
  • Mastectomy coding
  • Radiotherapy
  • Case coding

Hernia Surgery Coding

  • Hiatal/paraesophageal hernias: Type 1, 2, 3, 4
  • Open/laparoscopic hernia repair
  • Reporting mesh placement
  • Reporting hernias with other procedures: When is it appropriate?
  • Component separation release
  • Case coding

Applying 2015 Endoscopy Changes

  • New and revised codes: Upper GI coding: Esophagoscopy/EGD
  • Case coding

Colorectal

  • Lower GI endoscopy coding: Colonoscopy and stomal endoscopy
    • Sigmoidoscopy vs. colonoscopy
    • Diagnostic vs. therapeutic
    • Medicare reimbursement issues: Lower GI endoscopy coding
  • A step-by-step approach to colorectal surgery coding
  • Case coding

Appendix Surgery Overview

  • Lap vs. open
  • Coding laparoscopic repair of a ruptured appendix
  • When can an appendectomy be reported with other procedures?
  • Case coding

Strategic Appeals: Approaches and Essential Resources to Increase Your Chances of Success!
Gall Bladder Surgery and Liver Biopsies

  • Cholecystectomy
  • Liver biopsy
  • Case coding

Integumentary coding: Dos and don'ts

  • Lesions
  • Soft tissue tumor
  • Simple, intermediate, complex repairs: When can each be reported with lesion and soft tissue tumor excision?
  • Case coding

Endocrine Overview 

  • Thyroid
  • Parathyroid
  • Case coding

Trauma Coding Highlights

  • Liver and spleen repairs/resections
  • Reporting other procedures: Lacerations, chest tube, and more
  • Case coding

Register today!