Global Period for Surgery. Is it billable?

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1 Global Period for Surgery. Is it billable? August 10, 2017 Question: My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global. I was on vacation so my general surgeon partner saw the patient and admitted her. What should she bill for this? Answer: Since the patient is in a global period for the surgery, this is not billable, by you or any of your partners of the same specialty. From a billing perspective, you and your partners are a single billing entity. Therefore, you all share the global package of the patient s surgery. *This response is based on the best information available as of 08/10/17. Global Period for Surgery. Is it billable? July 27, 2017 Question:

2 My patient presented to the ED with an infection at the incision site from a surgery that I did 4 weeks ago. It has a 90 day global. I was on vacation so my general surgeon partner saw the patient and admitted her. What should she bill for this? Answer: Since the patient is in a global period for the surgery, this is not billable, by you or any of your partners of the same specialty. If you take the patient to the OR to treat the infection, you will bill that procedure with a 78 modifier, for related procedure retuned to the OR during the global period. From a billing perspective, you and your partners are a single billing entity. Therefore, you all share the global package. *This response is based on the best information available as of 07/27/17. Assistant or Surgery in Trauma June 8, 2017 Question: Coding Assistant surgeon or co-surgery in trauma. Which is it? My trauma surgeon partner and I operate on a patient with multiple trauma. Together we performed a trauma laparotomy: jointly repaired a laceration in the small bowel and packed the liver. My coder says this is not co-surgery. If not, what

3 is it? Answer: If you and your partner are both general surgeons, one surgeon will be the primary surgeon and one will be the assistant. Cosurgery is most typically surgeons of different specialties performing separate and distinct parts of a single CPT code. The scenario you describe is a second surgeon assisting with the procedure(s); a second pair of hands. This is assistant surgery. *This response is based on the best information available as of 06/08/17. KZA Webinar 2017 Update for Vascular Surgery Cost: $149

4 Click Register Today! Wednesday, December 14, pm 1pm cst Vascular coding just got a lot more complicated! Interventions of AV grafts/fistulas, which were completely revised in 2010, have once again undergone a complete overhaul for Now referred to as the Dialysis Circuit, the codes are further bundled. Now specific codes for dialysis circuit angioplasty and stenting debut in This information-packed webinar will explain these complicated codes. And there s more! Learning Objectives: Describe the key changes in coding dialysis circuit interventions. Identify the appropriate CPT code(s) for venous mechanochemical ablation. Discuss the use of the revised arterial and venous transluminal angioplasty codes. Summarize embolization changes for Who should attend?

5 Vascular surgeons General surgeon who treat vascular conditions Interventional radiologists Coders and billing staff Agenda: Here s What You ll Learn to Code Correctly and Get Paid! Nine new dialysis circuit codes How to use them correctly. How the change impacts RVU and reimbursements, including: 1. Dialysis circuit imaging: what s included (arterial and venous) 2. New codes for angioplasty, stenting, and thrombectomy 3. Defining and understanding central vs. peripheral segment 4. What about stenting with open revisions? Use of the four new arterial and venous angioplasty codes. Can stenting be reported on the same vessel? Are these codes used for angioplasty of an AV graft/fistula? Can we report diagnostic angiograms with these codes? What about catheterizations? How to use the new mechanochemical ablation codes. How do they compare to the RFA and laser ablation codes? What about reimbursement? Reporting moderate sedation in vascular interventions, which is no longer included (or paid), so how do you report and get reimbursed if you provide moderate sedation? Can t make the live broadcast? The webinar recording will be available on our website for purchase and download a few days after the live session.

6 Bonus: Teri will illustrate reporting changes due to new code introduction. As a faculty member on the national SVS coding courses, Teri works directly with the CPT advisors on vascular coding and provides accurate coding advice from the official source, as well as information on coding changes that are in the works. Find out about more about Teri Romano, RN, MBA, CPC, CMDP Consultant and Speaker Click Register Today! Wednesday, December 14, pm 1pm cst KZA Webinar 2017 Coding Update for Spine Surgery

7 Who should attend? Orthopaedic surgeons Neurosurgeons Practice managers Billing managers Coders Billing staff What s discussed: What s new for spine diagnosis coding (ICD-10-CM). What s new for spine procedural coding (CPT) including: Deletion of (intervertebral device) and replacement with 3 new codes including CMS RVU and collections impact. Deletion of a spine fracture code. Clarification of terms such as percutaneous, endoscopic and open. Changes to spinal steroid injection codes ,

8 Bonus: Kim will discuss some common spine procedure coding conundrums including: What s the difference between and The latest on billing a decompression code with an interbody fusion code (22630, 22633). Question and Answer Session Find out about more about Kim Pollock, RN, MBA, CPC, CMDP Consultant and Speaker Click Here to Purchase Moh s Surgery October 13, 2016 Question: I am having trouble coding the following situation. A new patient was referred by a general dermatologist to our Moh s surgeon with a suspicious lesion on the chest. A biopsy had not been previously performed and my surgeon performed a punch biopsy of the lesion, prepared the specimen for frozen section and determined the lesion was positive for basal cell

9 carcinoma of the chest. On the same day he bills for a one-stage Moh s procedure on the chest. Can I bill for the biopsy and Moh s on the same date or is it included in the procedure? Answer: The surgical pathology codes and and are part of the Moh s surgery and are bundled into The surgeon should not append Modifier 59 to these pathology codes unless they pertain to a separate biopsy/excision that does not involve Moh s surgery. However there are certain conditions in which Moh s and a biopsy can be reported on the same date in any of these instances: When the lesion for which Moh s surgery is planned has not been biopsied within the previous 60 days. When the surgeon cannot obtain a pathology report, with reasonable effort, from the referring physician. When the biopsy is performed on a lesion that is not associated with the Moh s surgery. In the situation you described since a previous biopsy was not performed in the past 60 days you can report the Moh s procedure with the biopsy and frozen section. You should report (Moh s surgery stage 1 of chest), (biopsy) and (frozen section). Make sure you append modifier 59 on the biopsy and frozen section to identify they are distinct and separate from the Moh s surgery. *This response is based on the best information available as of 10/13/16.

10 Betty A. Hovey Betty A. Hovey, CCS-P, CPC, CPMA, CPCD, CPB, COC, CPC-I, CDIP Consultant, Author, and Speaker Areas of Expertise Clinical Documentation Improvement Procedure and Diagnosis Coding Audits ICD-10 Education and Training E/M Auditing and Education

11 Publications Healthcare Business Monthly BC Advantage Physician Practice Management ICD-10 Monitor Memberships American Health Information Management Association American Academy of Professional Coders Betty is a nationally recognized healthcare consultant and speaker. She is an expert auditor and loves to help practices stay compliant and profitable. Betty states, Physicians work hard for their practices and they should be paid properly for what they do. Betty brings almost thirty years of healthcare experience with her. She has worked for practices both large and small with the same intensity and attention. She started out as a coder and worked her way up to managing practices and directing departments. Her areas of expertise include Dermatology, Plastic Surgery, Cardiology, Cardiothoracic Surgery, General Surgery, GI, E/M and procedural auditing, and ICD-10- CM/ICD-10-PCS. As a speaker and trainer, Betty brings a welcoming mannerism that her attendees relate to and enjoy. She brings humor and real life experience to her educational sessions that allow her to ensure that everyone understands the training and has a good time. Betty has educated coders, managers, health plans, administrators, non-physician practitioners and physicians all across the country. She has co-written manuals on ICD-10-CM, ICD-10-PCS, and CPT specialty areas. Before coming to KZA, Betty worked as the Director of ICD-10

12 Education and Training at the AAPC. She co-wrote training materials and presentations on all aspects of ICD-10. She spoke and trained across the country to assist practices in preparing for ICD-10. Prior to that, Betty ran her own consulting company. Her clients included Blue Cross Blue Shield of Tennessee, Blue Cross Blue Shield of Iowa, Blue Cross Blue Shield of North Dakota, Southeast Missouri Hospital, and many small practices. She offered coding and billing services, audits, coding education and training, and practice management assistance. Betty is a Certified Coding Specialist-Physician based (CCS-P) and a Certified Documentation Improvement Practitioner (CDIP) through the American Health Information Management Association (AHIMA). Through AAPC she holds certifications as a Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Professional Medical Auditor (CPMA), Certified Professional Coder for Dermatology (CPCD), Certified Professional Biller (CPB), and a Certified Professional Coder Instructor (CPC-I). Betty enjoys spending time with her family, including her two black labs. She is an avid reader and loves to spend time outside in the warm months. Gail Strindberg, MD This is a wonderful course. The information is really dedicated to current general surgery practices. It s also a great opportunity to speak with colleagues and see how they are dealing with the same situations.

13 New Patient Admission Charge September 29, 2016 Question: I took the General Surgery coding courses you taught in New York at The Cornell Club and believe you have already made a difference in how I code. I have a question. After I see a patient in the office and schedule an elective surgery, I prepare an H&P for this patient to be added to their chart upon admission for the planned elective surgery. A New Patient charge is generated at the office visit. Should there be an additional new patient admission charge generated at the time of their admission for the elective surgery, or is that considered part of the New Patient charge at the time of the office visit when the elective surgery was scheduled? Answer: Thank you for attending the American College of Surgeons coding course. I am very glad you found it helpful in your coding efforts. To answer your question, the patient visit at the time of the admission for elective surgery is part of the global package and not separately reported. *This response is based on the best information available as of 09/29/16.

14 Separate Procedure. What does it mean? February 2, 2016 Question: I noticed that some codes in general surgery have separate procedure at the end of the code, for example: 44005, open enterolysis (lysis of adhesions). What does that mean? Answer: The separate procedure designation means that this procedure is not reported if it is performed at the same time or through the same exposure as a related, more comprehensive procedure. The separate procedure is reported only if it is the only procedure performed or if it is unrelated or distinct from other procedure performed. So if adhesions are lysed as part of a larger procedure, for example a colectomy, only the colectomy is reported. *This response is based on the best information available as of 02/2/16.