Step by Step Lesson 13 - Surgery Guidelines and General Surgery

Chapter 13: Surgery Guidelines and General Surgery  Chapter Introduction and Learning Objectives  Chapter Introduction  Chapter Learning Objectives  Voices of Experience  Using the Chapter Outline  Lesson 13-1: Surgery Guidelines and General Surgery  Lesson Introduction  Lesson 13-1 Learning Objectives  Introduction to the Surgery Section 1. Surgery Section : a. The largest in the CPT manual b. Used by surgeons and also numerous other physicians 2. 19 subsections within the code range 10004-69990 a. The subsections are divided based according to: i. Medical specialty ii. Body systems 1. Integumentary 2. Cardiovascular 3. Surgery Subsections: a. General b. Integumentary System c. Musculoskeletal System d. Respiratory System e. Cardiovascular System f. Hemic and Lymphatic Systems g. Mediastinum and Diaphragm h. Digestive System i. Urinary System j. Male Genital System k. Reproductive System Procedures l. Intersex Surgery m. Female Genital System n. Maternity Care and Delivery o. Endocrine System p. Eye and Ocular Adnexa q. Auditory System r. Operating Microscope  Notes and Guidelines 1. Notes and Guidelines : a. Provide additional information about use of the codes b. Notes are located throughout the sections c. Guidelines are located at the beginning of the Surgery Section. 2. Examples of Notes: a. New and Revised text symbol i. Apply to CPT manual

b. Subsection notes i. Apply to the entire subsection c. Subheading notes i. Apply to the entire subheading d. Category notes i. Apply to the entire category e. Subcategory notes i. Apply to the entire subcategory  Additional Helpful Information

 Self-Comprehension Questions 1. Which of these codes are used when a more specific code cannot be found? a. Level III b. National c. Unlisted d. Both A and C 2. Unlisted codes and Level III codes are used when no more specific codes can be found  Self-Comprehension Questions 1. This must always accompany the submission of an unlisted code: a. History and physical report b. Pathology report c. Copy of patient file d. Special report 2. A special report must always accompany the submission of an unlisted code  Separate Procedure 1. When the parenthetical expression “(separate procedure)” follows a code description: a. The procedure is usually a minor procedure b. Minor procedures are considered incidental to a more major procedure 2. Example: a. A breast biopsy (19100, separate procedure) performed immediately before a radical mastectomy would be bundled into the mastectomy procedure and not be reported separately i. However, a breast biopsy was performed as the only procedure would be reported 3. Exception: a. As an example, a patient has a unilateral ovarian biopsy (58900) performed and is then brought back to the operation room for a total oophorectomy (58940) the same day b. The second procedure performed should have modifier -58 appended to the CPT code. i. (Staged or related procedure or service by the same physician during the postoperative period) ii. 58940-58  Self-Comprehension Questions 1. A “separate procedure” is: a. Coded when it is the only procedure performed b. Not coded when it is part of a more involved surgery at the same site c. May be coded along with another procedure depending on the circumstances d. All of the above 2. The separate procedure is “all of the above”  Lesson 13-1 Learning Activity 1. How many subsections are there in the Surgery section of the CPT manual? a. 15 b. 16 c. 17 d. 19 2. What code range represents those in the Surgery section? a. 10000-80000 b. 12000-70000 c. 10000-60000 d. 10004-69990

 Lesson 13-1 Quiz 1. When you use this code, a special report will always accompany its submission: a. Unusual b. Unlisted c. Uncomplicated d. Complicated 2. Lesson 13-1 Quiz Answer: a. B  Lesson 13-2: Surgical Package  Lesson Introduction 1. The surgical package is so important in coding because: a. It defines what services and materials are included with a surgical procedure 2. The contents of each surgical package are defined by the third-party payers 3. The package is a group of services NOT to be reported separately 4. The three major guidelines that will guide in further understanding the surgical package  Lesson 13-2 Learning Objectives  First Major Guidelines of the Surgical Package 1. First major guideline of the surgical section : a. Involves major surgical procedures b. Major surgical procedures usually include these services: i. Preoperative 1. Before surgery ii. Intraoperative 1. Surgical procedure iii. Postoperative 1. After surgery 2. Known as the global period 2. The surgical bundle: a. Known as a surgical package b. Includes a varying amount of services, depending on the payer c. Each payer decides what is in the bundle for each procedure i. Third-Payer Surgical Package 1. Most payers specify that for 90 days after a major surgery, all services related to the surgery are included in the package 2. Unbundling: a. To report separately for any of these bundled services 3. Unbundling is NOT appropriate 4. Never in the bundle: a. Anesthesia services provided by an anesthesiologist i. Never in the surgical package b. Anesthesia services are reported separately by the anesthesiologist 5. Local anesthesia provided by the surgeon is bundled with the surgical package  Self-Comprehension Questions 1. Major surgical procedures usually include which of the following services? a. Postoperative b. Preoperative c. Intraoperative

c. 30 d. 10 2. If a needle biopsy is performed in the office, would all third-party payers pay separately for the necessary supplies used during the biopsy separately? a. Yes b. No  Lesson 13-3: Surgical Package, Part II  Lesson Introduction 1. Major surgical procedures usually include: a. Preoperative service b. The procedure c. Postoperative service 2. If the surgical procedure is minor: a. Preoperative and postoperative services are variable b. Are usually reported separately  Lesson 13-3 Learning Objectives  Surgical Package, Part II 1. Third-party payers determine the number of follow-up days included on each surgical package a. Minor procedures may have zero follow-up days i. In this case, all follow-up services are reported separately b. If the payer determined that there were 10 follow-up days in a particular surgical package: i. Only those follow-up services provided to the patient after day 10 could be reported separately 2. It will be your responsibility to know what is included in each surgical package for each payer: a. So know what services to code  Complicated Note 1. The points you just reviewed about the surgical packages are very specific: a. They tell you to: i. “Report this” ii. “Don’t report that” iii. “Oh, yes, report that when this happens” 2. It all may sound like a very complicated puzzle at first: a. Know that you will learn the rules as you begin to apply them  Surgical Tray 1. Minor procedures usually do not include the cost of necessary supplies, such as a surgical tray a. Surgical tray : i. Contains these, depending on the procedure: 1. Needles 2. Suture material 3. Wipes 4. Drugs 5. Etc ii. Can be assembled to contain the specific items required by the physician 1. Or the trays can be purchased ready to go 2. Either way, there is expense involved when a surgical tray is used in a physician’s office iii. The surgical tray would only be coded for services provided IN the physician’s office

2. The third-party payer can, as always, decide when you can and cannot report the surgical tray: a. Contact your payers to ensure that you are reporting the surgical tray within their individual guidelines 3. Report the surgical tray with: a. CPT code 99070 from the Medicine section OR b. HCPCS A4550  Self-Comprehension Question 1. Which HCPCS code is used to report a surgical tray? a. 99070 b. A4455 c. A4550 d. J3841 2. HCPCS code used to report a surgical tray is A4550  Medical Terminology Review 1. Biopsy a. Removal of a small piece of living tissue for diagnostic purposes 2. -centesis a. Suffix meaning puncture of a cavity 3. -ectomy a. Suffix meaning removal of part or all of an organ of the body 4. -rrhaphy a. Suffix meaning suturing  Lesson 13-3 Learning Activity 1. According to the Surgery Guidelines, would the surgery package include the postanesthesia recovery area visit by the surgeon? a. Yes b. No 2. According to the Surgery Guidelines, is a digital block performed by the surgeon part of the surgery package? a. Yes b. No  Lesson 13-3 Quiz 1. When a minor procedure is provided to a new or established patient and that procedure is the major service, do you report both the E/M service and the procedure? a. Yes b. No 2. Lesson 13-3 Quiz Answer: a. B  Lesson 13-4: General Subsection  Lesson Introduction  Lesson 13-4 Learning Objectives  Medical Terminology Review 1. Incision a. Surgical cutting into 2. Ligation a. Binding or tying off 3. -otomy a. Suffix meaning incision into  General Subsection

a. False 7. Reimbursement for Category III codes is the same as Category I codes. a. False 8. Special report should include description of the nature, extent, and ______ for the procedure. a. Need 9. Special report should also include description of the time, effort, and ______ necessary to provide the service. a. Equipment 10. Surgical package reimbursement is decided by the: a. Third-party payer Chapter 13 Self-Practice Questions Part 2 1. Quantitative holotranscobalamin (vitamin B12 diagnostic test). (Category III code) a. 84999 2. Extracorporeal shock wave involving musculoskeletal system, high energy, NOS. (Category III code) a. 0101T 3. Unlisted vascular endoscopy procedure. a. 37501 4. Unlisted procedure of the posterior segment. a. 67299 5. Implantation of a total replacement heart system with recipient cardiectomy. (Category III code) a. 33927