FRIDAY

Successful Surgical Coding

Agenda

*agenda subject to change

7:00AM — 8:00AM

Check-in and Breakfast (provided)

8:00AM – 9:45AM

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- and assistant surgeon.

Same-Day Procedure Modifiers

  • Modifier 22: What justifies modifier 22 and how to increase your chances of payment?
  • Modifier 50: Which procedures accept a bilateral modifier?
  • Modifier 51 vs. 59: How do you know which one to use? How does reimbursement differ for each?
  • Modifier 52 vs. 53: What is the difference and how are they used in general surgery?

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

Documentation for Unlisted Procedures

  • How to report and get paid.
  • Template letter for reporting unlisted codes.
  • Case scenarios.

9:45AM – 10:00AM

Break

10:00AM — 12:00PM

Surgical Coding and Documentation

Surgical Approaches and Code Selection: Percutaneous vs. Open vs. Laparoscopic – Does it Matter?

Radiology Coding and Documentation for Surgeons

  • Fluoroscopy and ultrasound: Is a separate report required?
  • Documenting imaging with central lines: Fluoroscopy or ultrasound or both?

Hernia Surgery

  • Hiatal/paraesophageal hernias: Type 1, 2, 3, 4.
  • Open/laparoscopic hernia repair.
  • Reporting other procedures with hernias codes – CPT rules vs. payor realities.
  • Reporting mesh placement.
  • Reporting mesh removal; infected and non-infected mesh.
  • Component separation release/abdominal reconstruction.
  • Case scenarios.

Gallbladder and Liver Surgery

  • When can a cholangiogram be separately reported?
  • Liver biopsy. Percutaneous vs. open
  • Liver resections – How many hepatectomies (47120) are too many?
  • Case scenarios.

12:00PM — 1:00PM

Lunch

1:00PM — 2:30PM

Procedure Coding (continued)

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 vs. Robotic
  • 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.
  • Case scenarios.

Appendix Surgery

  • Lap vs. Open
  • Laparoscopic repair of a ruptured appendix.
  • Case scenarios.

Intra-abdominal Tumor Resection

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

2:30PM — 2:45PM

Break

2:45PM — 4:00PM

Procedure Coding (continued)

Endocrine Surgery

  • Thyroid
  • Parathyroid
  • Adrenal

Breast Procedures

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

Bariatric Surgery

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

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Coding Coaches