General Surgery Coding: Revenue and RVU Optimization in General Surgery


*agenda subject to change

8:00AM – 8:30AM

New 2022 CPT Codes in General Surgery

  • New Foreign body guidelines
  • Integumentary revisions
  • New Category I code for POEM procedure
  • New Category III codes: 0647T and 0652T, billing and getting paid?

8:30AM – 9:30AM

The Global Surgical Package and Modifiers in General Surgery

  • Global Surgical Package
    • What’s included in the global package, and what can be separately reported?
    • Deconstructing the global payment: surgical splits, RVUs. and physician time
    • Medicare Fee changes in 2022
  • Surgeon Role Modifiers
    • Co-surgery vs. assistant: Are you reporting these correctly?
    • Payor expectations for co-surgery and assistant surgery documentation
    • Reimbursement: difference between co- and assistant surgeon
  • Same-Day Procedure Modifiers
    • Modifier 22: What justifies modifier 22? and how to increase your chances of payment
    • Modifier 50: Which procedures accept a bilateral modifier?
    • Modifier 51 vs. 59: How do you know which one to use? How does reimbursement differ for each?
    • Modifier 52 vs. 53: What is the difference, and how are they used in general surgery?
  • Modifiers for Additional Procedures Performed During the Global Surgical Period
    • Modifier 58: Documenting staged procedures: Do they always need to be preplanned? What about repeating a resection after pathology shows more margins?
    • Modifier 79: What defines an unrelated procedure? Is a different diagnosis essential?
    • Modifier 78: Does this apply to in-office procedures? How do I report in-office treatment of postoperative complications?

9:30AM — 12:00PM

Surgical Coding and Documentation

  • Surgical Approaches and Code Selection; Percutaneous vs. Open vs. Laparoscopic –
    Does it Matter? What is hand-assisted?
  • Operative Note Documentation Best Practice Op Note Format: Documentation to optimize coding accuracy and revenue
  • Hernia Surgery
    • Hiatal/paraesophageal hernias:
    • Type 1, 2, 3, 4.
    • Open/laparoscopic hernia repair
    • Reporting another procedures with hernias codes – CPT rules vs. payor realities
    • Reporting mesh placement
    • Reporting mesh removal
  • Abdominal Reconstruction/Component Separation
    • Documentation imperatives
    • Myocutaneous flaps vs. Rives Stoppa
  • Bariatric procedures NEW!
    • Open and laparoscopic
    • Revisions
    • Can a hernia repair be reported in addition to a sleeve gastrectomy?
  • Gallbladder and Liver Surgery
    • Cholecystectomy. Open vs laparoscopic?
    • When can a cholangiogram be separately reported?
  • Liver Surgery
    • Liver biopsy: percutaneous vs open
    • Liver resection coding

12:00PM — 12:45PM


12:45PM — 4:00PM

Endoscopy Overview

  • General concepts in endoscopy coding; completion endoscopy –
    billable or not?
  • Moderate sedation: are you documenting enough?
  • Colonoscopy: sigmoidoscopy vs. colonoscopy: How far is far enough?
  • Colorectal Surgery
    • Approach matters, laparoscopic vs. open vs. robotic
    • What’s the difference between colostomy and coloproctostomy? a sigmoid colectomy and a low pelvic anastomosis?
    • Total and subtotal colectomy; Is there a difference?
    • Stoma creation, revision, and closure
    • Case scenarios
    • Appendix Surgery
  • Breast Procedures
    • Breast biopsy: percutaneous, incisional, and excisional
    • Sentinel node mapping and excision
    • Lymph node dissection: How does this change coding?
    • Mastectomy coding: lumpectomy, simple and radical mastectomies
    • Reporting closures and local advancement flaps
    • Can placement of a marker in a lumpectomy cavity be reported?
    • Case scenario
  • Intra-Abdominal Lesion Resection
    • What can be separately reported?
    • Coding HIPEC and getting paid
  • Endocrine Surgery
    • Thyroid

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