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

Successful Surgical Coding

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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 format
  • 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