Question

Where do you find guidelines and notes for the coding procedures listed in the Surgery section of the CPT? How will these guidelines affect the way coding is completed?  What are the general characteristics of the surgical package? How is it determined whether a component is included or excluded in a surgical package? What are the advantages to having services bundled in packages rather than billed individually?

Answer 1

CPT is a medical code set that is used to report medical, surgical and diagnostic procedures and services to entities such as physician , health insurance companies and accreditation organizations .

guidelines and notes for coding procedures for surgical section we can find in CPT code book. as introductory notes at the beginning section or sub section .

reference introduction section , front and back covers and addendums.

the coding procedures listed in the surgery section of CPT Code book from 10021-69990, category -1 CPT codes arranged by numerical range .

Introduction / surgery /format

1. guidelines before section - p47-50
2. subsection info with coding ranges
3. unlisted procedure coding ranges

Each section

• with subsections by anatomical sites (s) then type of procedure / surgery
• each section has similar format , but different

surgical documentation guidelines affect the way of coding :

• code the procedure with the cpt /hcpcs codes that mostly describes the service provided .
• accurate and complete coding
• physician documentation is used to correct code assignment and appropriate reimbursement
• only documentation services may be coded.
• correct coding require a group of procedures with the appropriate comprehensive code
• follow global surgery concept
• use of modifiers to the service provided .

general characters of surgical package 1

• surgical procedures and categorized as a major or minor surgery
• is it included reimbursed for pre - intra - and postoperative care
• post operative care varies according to the assigned to global period
• which designates 0, 10,90 post operative days

include in surgical package

• in surgical package includes global services and and pre intra post operative services
• evalution and management subsequent to the decision for surgery on the day before or day of surgery.
• local infiltration
• immediate postoperative care
• writing orders
• post op follow ups
• excludes in surgical package
• initial consultation
• services of other physicians
• un related diagnosis
• treatment for the underlying condition
• diagnosis test and procedures

advantages of having surgical bundle in pacakage rather than billed individual

simplification

quality of care

payment distribution difficulties

limit of e3ffectiveness