1. Slide 1 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CHAPTER 17 SURGERY GUIDELINES AND GENERAL SURGERY

2. Slide 2 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgery Section Largest CPT Section Section format: –10021-_____ Divided by subspecialty –Integumentary –Cardiovascular 69990

3. Slide 3 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Notes and Guidelines Throughout section Information varied and extensive “Must” reading

4. Slide 4 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. CPT Manual Text Changes Figure: 17.1 ►◄ Indicates text changes from previous edition

5. Slide 5 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Subsection Notes Figure: 17.2 Subsection notes apply to entire subsection

6. Slide 6 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Subheading Notes Figure: 17.3 Subheading notes apply to entire subheading

7. Slide 7 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Category Notes Figure: 17.4 Category notes apply to entire category

8. Slide 8 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Subcategory Notes Figure: 17.5 Subcategory notes apply to entire subcategory

9. Slide 9 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Additional Helpful Notes Figure: 17.6 Parenthetical information

10. Slide 10 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Unlisted Procedure Codes Used only when more specific Category I or Category III code not found Written report accompanies submission Each unlisted code service paid on case- by-case basis

11. Slide 11 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Separate Procedure “Separate procedure” follows code description Incidental to more major related procedure –Breast biopsy –Before radical mastectomy, same operative session, would not be coded, as only procedure performed, would be coded

12. Slide 12 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Separate Procedure Reported When Only procedure performed With another procedure –On different ___ –Unrelated to major procedure site

13. Slide 13 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Minor Procedures Often on service-by-service basis Often do not have ______ of services Third-party payer decides what is in a surgical bundle Minor procedure for Medicare has 0 or 10-day global period bundle

14. Slide 14 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Third-Party Payers Decide what is in a surgical bundle Medicare has the “Correct Coding Initiative” edits –Specify what is in bundle

15. Slide 15 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Major Guideline of Surgical Packages Major surgical procedures usually include: __________ (before) ___________ (during) ___________ (after—also known as global period) Minor complications (Cont’d…) Preoperative Intraoperative Postoperative

16. Slide 16 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Major Guideline of Surgical Packages (…Cont’d) One bundle—one price Minor procedure may have no bundle Varies by payer

17. Slide 17 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Major Guideline Example Most payers specify __ days after major surgery –All services related to surgery are in package –Including preop, intraop, and postop Separate reporting = Unbundling 90

18. Slide 18 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Never in Bundle General anesthesia services Reported separately by _____________ anesthesiologist

19. Slide 19 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgical Package Minor procedure: preop and postop services are sometimes reported separately Same day may be included in performance of the procedure Can be reported separately if specified by payer

20. Slide 20 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Minor Surgery Example Needle biopsy in office Report –________ (biopsy) –_______ (surgical tray) Procedure Supplies

21. Slide 21 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Surgical Tray Needles, suture materials, wipes, drugs Report surgical tray with –_____ CPT, Medicine section (Medicare bundles into procedure) –_____ HCPCS (not separately reported to Medicare) 99070 A4550

22. Slide 22 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Reporting Surgery Outpatient coders: Physician payment (professional) Inpatient coders: Hospital payment (facility)

23. Slide 23 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. General Subsection (10021, 10022) Fine needle aspirations with or without (w/wo) ______ guidance Pathology _____, _____, and _____ for aspirate evaluation From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby. imaging 88172 88173 Figure: 17.9 88177

24. Slide 24 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 17 SURGERY GUIDELINES AND GENERAL SURGERY