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

Office Procedure and E/M 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 short changing 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:

  • Select the correct category of code and level of service for E/M visits.
  • Appropriately assign modifiers to E/M visits.
  • Accurately code lesion excision and repair codes.
  • Understand teaching physician rules and coding for services
  • Accurately code new FNA and incisional biopsy codes
  • Understand and report diagnosis codes
  • Assess and improve one key aspect of the revenue cycle function.
  • Implement strategies for collecting from patients with high-deductible health plans.

What's on the Agenda

Payment for Surgical Services

  • Global surgical package for major and minor procedures
  • Pre-op and post-op services that are – and aren't – part of the global payment
  • Don't lost revenue and don't risk an audit using E/M modifiers 24, 25, and 57
  • Know the difference between CPT and CMS definition of the global package
  • Coding scenarios

Medicare Physician Fee Schedule

  • Update to CMS coding policies for 2019
  • Relative Value Units (RVUs)
  • Status indicators
  • NEW: Update on telecommunication coding
  • Keep informed about changed teaching physician rules

Category of E/M Services

  • Avoid denials by selecting the correct category of code
  • Consultation codes – many payers still accept CPT consult codes
  • Inter-professional consultation codes NEW
  • Coding scenarios
  • Use these reference sheets to select the correct type of service to report

Level of E/M Services

  • Code the level of service that is documented and supported by medical necessity
  • Selecting your code based on documentation
  • How to differentiate straightforward, low, moderate and high medical decision making
  • Using time to select a code
  • NEW: Update to CMS's documentation rules for office services
  • Documenting inpatient, observation and emergency department services

Critical Care

  • Critical care and trauma teams
  • Determine when critical care is part of the global payment and when it isn't
  • Understand the difference between CPT and CMS rules for critical care

Screening Colonoscopy

  • HCPCS and CPT codes for screening colonoscopy
  • Change in plans: Coding when a screening results in a procedure
  • Use of modifiers 33 and PT
  • NEW: Diagnosis coding for screening colonoscopy

Surgical Procedures Commonly Done in the Office

  • Excision of benign and malignant lesions
  • NEW: New CPT codes for fine needle aspiration and incisional biopsies
  • Laceration repair

Diagnosis Coding

  • Establishing medical necessity for a service
  • Anatomy of a payment policy
  • Risk-adjusted diagnosis coding and HCCs
  • Signs, symptoms, screening and surveillance

Practice Management

  • Coding related denials
  • Fee schedule analysis
  • Surgical deposits
  • Customer service in the billing and coding departments