Day 17--Friday--Quiz--pp. 76-95 in Textbook

complications

CPT Surgical Package for Providers: Global Surgery Payment—pp. 69-70

• Procedure

• Local, digital block, or topical anesthesia

• One related E/M on a date prior to or on the date of procedure

• Immediate postop care

• Writing orders

• Typical postop followup care, NOT including ________

surgical package

It is treated as a single service for purposes of reimbursement, and a single payment is issued for each package of related surgical services.

99205; 99024; 99024

A new patient is seen for abdominal pain:

• Office Visit 1: a medically appropriate history and physical examination and high medical decision-making led to the conclusion that an appendectomy is necessary immediately

• Surgery: An appendectomy is performed.

• Office Visit 2: One week later, the patient returns to the physician’s office 

• Office Visit 3: Four days later, the patient returns for suture removal.

  • Code Assigned: _______, ________ (no charge), _________ (no charge)
    

T81.40XA

Dr. Smith performed a cholecystectomy. Two weeks later, the patient returned with complaints of redness, inflammation, and oozing from the wound site. Dr. Smith determined that the patient had developed an infection at the operative wound site and treated it appropriately. 

For the second office visit, an ICD-10-CM codes that describes the reason for the visit (such as ________ infection following a procedure, initial encounter.)

Global Surgery Payment

CPT Surgical Package for Provider: _______ ________ _________

outpatient

CPT Surgical Package for Providers: Global Surgery Payment

outpatient

Surgical package DOES NOT apply in the hospital _______ setting.

in[patient

CPT Surgical Package for Providers: Global Surgery Payment—p. 71

• __________ hospitals report all postoperative visits, including dressing changes.

E/M code

A patient returned to the outpatient clinic of Central Hospital for a change of surgical dressing. The hospital assigns ICD-10-CM code Z48.01, Encounter for change or removal of surgical wound dressing, to identify the reason for the visit. This code appropriate to the circumstance (new or established) reflects the service rendered.

Major Surgery

Global Surgical Package: Medicare Definition

• which surgery?

• 90 days

Minor Surgeries

Global Surgical Package: Medicare Definition

• which surgery?

• 0-10 days 

complications 

Global Surgical Package: Medicare Definition

• Major surgeries (90 days postop care), any services related to the surgery that do not involve return to the OR are included in the surgery code—including _________. 

global surgery

The Medicare definition of _____ _____ used for major surgeries includes the following types of services:

• The actual surgical procedure

• Preoperative services after the decision is made to operate, beginning with the day before the day of surgery for major procedures and the day of surgery for minor procedures.

• Follow-up visits during the postoperative period of the surgery that are related to recovery from the surgery.

• Complications following surgery: all additional medical or surgical services required of the surgeon during the postoperative period of the surgery because of complications that do not require additional trips to the OR.

• Insignificant surgical procedures not performed in the operating room, including dressing changes, removal of operative packs, and care of the operative incision site; removal of sutures, staples, wires, lines, tubes, catheters; routine peripheral intravenous lines; removal of nasogastric tubes and rectal tubes; care of tracheostomy tubes

Followup Care

________ Care for Diagnostic and Therapeutic Procedures—p. 71

• DOES NOT include any global surgery package.

procedure 

Follow-up Care for Diagnostic and Therapeutic Procedures—p. 71

• Only care for the ______  itself is included.

complications, exacerbations and reoccurrences

Followup Care for Diagnostic and Therapeutic Procedures—p. 71

• Report all other codes related to these procedures, including complications, e_______, and r________

exacerbation

getting worse

separate procedure 

The CPT code book defines this as one that, when performed in conjunction with another service, is considered an integral part of the major service; therefore, it should NOT BE CODED separately. 

integral

Is the separate procedure code an _____ part of another procedure?

DO NOT; intricate

Separate Procedure

• If so, (DO OR DO NOT) code the separate procedure; report only the more ______ procedure.

Yes

Separate Procedure

• Salpingo—oophorectomy, complete, or partial, unilateral or bilateral 

  • is this a separate procedure?

    • 58720

NOT

Separate Procedure

• 58720, Salpingo—oophorectomy, complete, or partial, unilateral or bilateral 

• 58150, Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s) with or without removal or ovary(s)

  • 58720 = ONLY the fallopian tubes and ovaries are included.

  • 58150 includes everything in 58720. Therefore, 58720 is ____ coded with 58150.

Unbundling

refers to the practice of using multiple codes that describe individual components of a procedure rather than an appropriate single code that describes all the steps in the procedures performed

Bronchoscope Insertion

A flexible tube with a light and camera is inserted through the nose or mouth and guided into the lungs.

Cell Washing (Bronchoalveolar Lavage - BAL)

Sterile saline solution is squirted into the airways.

Sample Collection

The saline, along with cells and other substances from the lung's lining, is suctioned back through the bronchoscope into a sterile container

Analysis

The collected sample is sent to a lab for analysis under a microscope.

31628 

Separate Procedure—p. 72

Example of When Not to Use a Separate Procedure Code 31622 vs. 31628—(See your CPT.)

• For a flexible bronchoscopy with cell washings (31622) and a transbronchial lung biopsy, single lobe (31628).

• Report ONLY ______ because 31622 is a separate procedure and would NOT be assigned with 31628 since 31622 is the base code for 31628. (See NCCI edits to double check.)

Endoscopy

Through a natural opening.

dvp[r

Endoscopy

• “______” code must be reported for all laparoscopic surgical approaches in all Surgery sections [laparoscopic, thoracoscopic, or hysteroscopic approaches].

unlisted

Endoscopy

• If a “scope” code is not available, use an ______  “scope” code for the closest anatomic site available.

lack

Example of Unlisted Laparoscopic Code

• No Specific Code Available: The primary reason is a _____ of a specific CPT code for the exact laparoscopic or robotic procedure that was performed.

unlisted code

Example of Unlisted Laparoscopic Code

New Techniques

• When providers use new laparoscopic or robotic techniques that were not in the CPT, an this code is required because the existing codes may only specify an "open" approach.

• Example: Unlisted Laparoscopic Cystectomy

51596; 51999

Example of Unlisted Laparoscopic Code Scenario:

A surgeon performs a complete cystectomy, involving constructing a neobladder using a laparoscopic approach.

• CPT Code for Open Technique: The CPT code for the open technique is ________

• Laparoscopic Code: Since there is not a specific laparoscopic code for this procedure, you would use the Unlisted Code ________ Unlisted laparoscopy procedure, urinary system.

robotic procedure

which procedures use the same code as other laparoscopic procedures?

laparoscopic and HCPCS

The patient’s insurance company may request both the ______ procedure and: _____ S2900 Surgical techniques requiring use of robotic surgical system— but no reimbursement usually is given.