Are you earning what you should for your surgery? Most plastic surgeons would say “no” with a grimace of disgust, and many would blame the shortfall on third-party payors. But many fail to recognize that they themselves are partly responsible for poor receivables – because they or their office staff are not properly utilizing CPT codes.

In a difficult economy, it’s more critical than ever that practices code correctly. ASPS recently put together a series of three CPT Coding Workshops for 2009, aimed at teaching plastic surgeons and their staffs the best coding practices utilizing the most current definitions for CPT codes.

The upcoming Coding Workshops will be held:

• April 24-25 in San Diego
• June 19-20 in Atlanta
• August 14-15 in Chicago

More plastic surgery case coding

In answer to past CPT Coding Workshop attendees’ feedback, the time devoted to plastic surgery case coding has been expanded for 2009. In addition, the course’s traditional evaluation and management (E&M) coding segment has been produced as a series of pre-course online modules. Those interested in brushing up on E&M can view the course modules ahead of the workshops – and then participate in a Q&A session about the material during the workshop.

“The CPT workshops cover all aspects of plastic surgery, including lesions and repairs; breast, flap and hand surgery; grafts; facial fractures and microsurgery,” notes ASPS Coding and Payment Policy Committee member Raymond Janevicius, MD, who also writes the popular PSN column CPT Corner.

“CPT coding is critical to accurately describe the services you render and to obtain maximum, fair reimbursement for these services,” he says. “But this year’s courses will differ from previous workshops – there will be much more ‘hands on’ coding in a variety of reconstructive surgery situations. Important practice management issues also will be addressed.”

Erin Kennedy, MD, a member of the ASPS Practice Management Education Committee – which oversees the workshops – says this year’s courses are aimed at helping both the new surgeon entering practice, and the experienced “old hand” at coding.

“Plastic surgeons just starting practice will hear about coding, modifiers, appeals and the pitfalls of getting their practices off the ground,” Dr. Kennedy says. “The workshops provide an overview of common coding scenarios within various aspects of our specialty. They also cover the new rules, codes and combinations that will help the experienced plastic surgeon accurately code and understand how to optimize payments.”

Dr. Kennedy notes that the breast coding section of the course in particular has been updated for 2009. “The breast section has been extensively overhauled this year. The examples, reference material and pearls should help the surgeon and staff navigate the multiple combinations of breast surgery and reconstruction.”

Why is this course important?

“Accurate coding matters whether you’re doing reconstructive or aesthetic surgery,” says Karen Zupko, who oversees the CPT Workshop course content creation and teaching for ASPS. “Whether you are in or out of network for reconstructive surgery, accuracy matters. You want to be sure that patients receive the maximum possible coverage if you’re out of network, and you want to be sure your codes result in payment of contract allowables if you’re in-network.”

Zupko says her company’s audits frequently find practices using old codes that are no longer appropriate, as well as not using modifiers correctly. “When we audit, we see dozens of mistakes,” she says. “It happens more often than you would think. Practices don’t use modifiers accurately. For example, there’s a lot of confusion regarding the use of -59 (which indicates a “distinct procedural service”).”

Dr. Janevicius adds that correct coding can help avoid one of the more significant non-medical problems. “In the current economic milieu, insurance companies are also looking for ways to save money, and we may see an increase in the number of post-payment audits,” he says. “Accurate coding will help decrease the chances for an audit – and will provide concrete documentation in the event that you are audited.”

Why code for aesthetic cases?

While aesthetic cases may not be billed to insurance companies, Zupko says surgeons need to understand how to code them because cases frequently have a mix of reconstructive and aesthetic components. “Nasal surgery is one example,” she says. “You need to know how to code both.

“For purely aesthetic cases,” she adds, “surgeons should be interested in tracking what they’ve done, what quotes were given out to patients who didn’t schedule, etc. If you don’t measure it, you can’t manage it. When cases are entered into the computer helter-skelter by the assistant of the moment, reviewing reports is like reading fiction. This goes for injectables in a big way. We also find plastic surgeons using billable CPT codes for aesthetic consultations. We recommend creating tracking codes for these visits instead of mixing the lines of business.”

Zupko says that coding remains important when working with managed care. “For one thing, you want to avoid denials and downcoding,” she says. “You do that by understanding the options and nuances, and sending out claims correctly the first time. Also, if your practice does depend on insurance payments, you don’t want to attract unwanted attention to yourself.”

Can you survive a coding ‘audit’?

Zupko notes that Medicare “recovery audits” are increasing in practices around the country. It’s a trend that likely will continue, she says.

“The first round of audits was found by CMS to be profitable,” she says. “The agency is taking money back – and lack of documentation, incorrect codes and lack of medical necessity are a few of the reasons it has done so. Usually, CMS finds errors in the evaluation and management coding. These are easy to fix.

“The other errors are process errors,” Zupko adds. “One recent client found that delegating coding to his staff resulted in a hearing with a medical board. They were billing incorrectly, and the surgeon was just too busy to ‘check on the girls.’ The result was big legal fees. We recommend that surgeons code their own cases. Ask staff for feedback and that they review the EOBs.”

Zupko says one of this year’s CPT Workshop goals is the correction of office process errors: “We’ve made it a point this year to include a number of hot topics.”

“In addition, too many practices are sheepish,” she adds. “They fail to appeal payment denials, and this is a big problem. Especially today, insurance companies with falling revenue are denying multiple procedures but paying if it’s appealed. It’s a game – an irritating game, but if you understand it, you can recoup that money.”

“The workshop is really an excellent resource for staff,” Dr. Kennedy notes. “Billers and coders will better understand the process and where some of the errors and denials are coming from.

“Another benefit is that ASPS Coding and Payment Policy Committee members will be on hand to answer questions, discuss coding concerns and review actual case examples,” she adds. “I’ve spent considerable time discussing not only what procedure was performed, but what was dictated and how the office staff coded – and I’ve helped review the problems that kept the surgeon from being paid. It’s a wonderful opportunity for attendees.”

Never too late

The CME learning objectives for the 2009 Coding Workshops are to:

• Utilize the changes in 2009 CPT codes that affect plastic surgery practices
• Apply correct coding principles to breast reconstruction cases
• Differentiate expected procedural reimbursement and analyze actual reimbursement
• Develop a keen understanding of how Medicare reimbursement policies may affect other payers’ payments and policies
• Distinguish when and how to balance-bill a patient if the practice is in-network vs. out-of-network

“I’ve attended and proctored the workshops for many years now, and I still come home with new, useful information to apply to my practice,” says Dr. Janevicius. “The coding and reimbursement milieu changes significantly from year to year. Every plastic surgeon should attend one of these workshops every three or four years.”

To register for one of the ASPS CPT Coding Workshops, call ASPS Member Services at (800) 766-4955, or visit www.plasticsurgery.org and click on the Medical Professionals tab. The San Diego, Atlanta and Chicago courses are listed in the center column of the page.

(April 2009, Plastic Surgery News)