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:

  • Correctly code common general surgery procedures including breast, endoscopy, colorectal, bariatric, trauma, gall bladder, liver, hernia, and more.
  • Identify areas for improvement in surgical documentation.
  • Accurately apply modifiers when they are required and understand their impact on reimbursement.
  • Understand how to report and get paid for unlisted procedures.
  • Integrate 2019 CPT coding changes and guidelines into practice.

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 t surgery documentation.
  • Reimbursement: Difference between co- 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.
  • Modifier 79: What defines an unrelated procedure?
  • Modifier 78: Does this apply to in-office procedures? .

Revenue Optimization; 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?
  • Documenting imaging with central lines: fluoroscopy or ultrasound or both?

New CPT Codes 2019

  • Gastrostomy tubes coding 2019
  • PICC coding 2019

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

All About Implants

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

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
  • Partial colectomy and proctectomy
  • Coding a low pelvic anastomosis and diverting ileostomy
  • Defining LAR
  • What's the difference between colostomy and coloproctostomy?
  • Total and subtotal colectomy: is there a difference?
  • Stoma creation, revision and closure
  • Colotomy/Enterotomy
  • Case scenarios

Debridement and Wound Vac Coding

Damage Control Surgery

Appendix Surgery

  • Lap vs Open
  • Laparoscopic repair of a rupture appendix
  • Case scenarios

Bariatric Surgery

  • Coverage essentials: does pre-authorization always guarantee payment?
  • Paraesophageal hernia repair: When is it separately reported?

Breast Procedures

  • Breast biopsy: percutaneous, incisional and excisional
  • Sentinel node mapping and excision
  • Mastectomy coding: Lumpectomy, simple and radical mastectomies
  • IORT coding
  • Case scenarios

Endocrine Surgery

  • Thyroid
  • Parathyroid
  • Adrenal

Intra-Abdominal Lesion Codes

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