Who Should Attend This Course
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.
As a result of this course participants will be able to:
- Correctly code common general surgery procedures that include breast, endoscopy, colorectal, bariatric, trauma, gall bladder, liver, hernia, and more.
- Accurately apply modifiers when they are required and understand their impact on reimbursement.
- Understand how to report and get paid for unlisted procedures.
- Integrate 2017 CPT and HCPCS coding changes and guidelines into practice.
What’s On the Agenda
The Global Surgical Package
- What’s included in the global package and what can be separately reported.
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- and assistant surgeon.
- Illustrate key points
Same-Day Procedure Modifiers
- Modifier 22: What justifies modifier 22 and how to increase your chances 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 XE, XP, XS, XU: When to use as an alternative to modifier 59.
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?
Documentation for Unlisted and Carrier Priced Procedures
- How to report and get paid
- Template letter for reporting unlisted codes
Coding for Common Patient Scenarios
- Breast biopsy and placement of localization devices: open and percutaneous
- Breast mass: incisional versus excisional biopsy
- Sentinel lymph node mapping
- Lymph node excision: When is it separately reported?
- Mastectomy coding: Lumpectomy, simple and radical
- 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/abdominal reconstruction
- Medicare G codes for endoscopy
- Upper GI Coding
- EGD vs. esophagoscopy
- Using the 52 and 53 modifier with upper GI endoscopy
- EGD coding: Diagnostic and therapeutic, including PEG placement, biopsy and lesion excision, and more
- Sigmoidoscopy vs. colonoscopy: How far is far enough?
- Diagnostic vs. therapeutic
- Reporting Moderate Sedation
- Approach matters: laparoscopic versus open
- Partial colectomy (Hartmann’s procedure, LAR)
- 44140 vs 44160
- Total colectomy
- Coding a colectomy with diverting ileostomy
- Abdominal perineal resection (APR)
- Stoma creation, revision, and closure
- Coverage policies: Clinical criteria and approved procedures
- Paraesophageal hernia repair: When is it separately reported?
- Reporting additional procedures during the global period
Intra-Abdominal Tumor/Cyst Resection
- When is an omentectomy separately reported?
- Selecting the right code(s)
- Hyperthermic intraperitoneal chemotherapy (HIPEC) coding
- Lap vs. Open
- Laparoscopic repair of a ruptured appendix
- When can an appendectomy be reported with other procedures?
Gall Bladder and Liver Surgery
- Liver resection vs. biopsy
- Chest tube, intubation, emergency thoracotomy, and more
- Abdominal trauma coding: Liver, spleen, intestine repair and resection
- Damage control surgery and subsequent surgeries
- Reporting multiple traumas