CHAPTER 17 SURGERY GUIDELINES AND GENERAL SURGERY Copyright

Surgery Section • Largest CPT Section • Section format: 69990 – 10021 -_____ •

Notes and Guidelines • Throughout section • Information varied and extensive • “Must” reading

CPT Manual Text Changes Figure: 17. 1 ►◄ Indicates text changes from previous edition

Subsection Notes Figure: 17. 2 • Subsection notes apply to entire subsection Copyright ©

Subheading Notes Figure: 17. 3 • Subheading notes apply to entire subheading Copyright ©

Category Notes Figure: 17. 4 • Category notes apply to entire category Copyright ©

Subcategory Notes Figure: 17. 5 • Subcategory notes apply to entire subcategory Copyright ©

Additional Helpful Notes Figure: 17. 6 • Parenthetical information Copyright © 2014 by Saunders,

Unlisted Procedure Codes • Used only when more specific Category I or Category III

Separate Procedure • “Separate procedure” follows code description • Incidental to more major related

Separate Procedure Reported When • Only procedure performed • With another procedure site –

Minor Procedures • Often on service-by-service basis bundle of services • Often do not

Third-Party Payers • Decide what is in a surgical bundle • Medicare has the

Major Guideline of Surgical Packages • Major surgical procedures usually include: • Preoperative _____

Major Guideline of Surgical Packages (…Cont’d) • One bundle—one price • Minor procedure may

Major Guideline Example • Most payers specify __ 90 days after major surgery –

Never in Bundle • General anesthesia services • Reported separately by anesthesiologist _______ Copyright

Surgical Package • Minor procedure: preop and postop services are sometimes reported separately •

Minor Surgery Example • Needle biopsy in office • Report – Procedure ____ (biopsy)

Surgical Tray • Needles, suture materials, wipes, drugs • Report surgical tray with –

Reporting Surgery • Outpatient coders: Physician payment (professional) • Inpatient coders: Hospital payment (facility)

General Subsection (10021, 10022) • Fine needle aspirations with or without (w/wo) imaging ______

Conclusion CHAPTER 17 SURGERY GUIDELINES AND GENERAL SURGERY Copyright © 2014 by Saunders, an

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

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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 10

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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 11

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

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

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

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

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

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 Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 19

Surgical Tray • Needles, suture materials, wipes, drugs • Report surgical tray with – _____ 99070 CPT, Medicine section (Medicare bundles into procedure) – A 4550 _____ HCPCS (not separately reported to Medicare) Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 21

General Subsection (10021, 10022) • Fine needle aspirations with or without (w/wo) imaging ______ guidance 88177 for • Pathology _____, 88172 _____, 88173 and _____ aspirate evaluation Figure: 17. 9 From Forbes CD, Jackson WF: Color Atlas and Text of Clinical Medicine, ed 3, 2003, Mosby. Copyright © 2014 by Saunders, an imprint of Elsevier Inc. Slide 23