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