Coding for a general surgery practice, whether a solo or group practice, is an immensely complex task. General surgery is comprised of a wide range of services and procedures that run the gamut from routine to the profoundly complicated. General surgeons conduct surgical measures including endoscopic procedures and certain repairs, TAP anesthetic blocks, and procedures relating to the alimentary canal (digestive system organs), breasts, endocrine system, the skin, certain vascular concerns, and traumatic injury. Some of the more difficult claims to code involve bilateral surgeries and multiple surgical procedures performed the same day.
Surgical procedures are often considered “packaged services” which include pre-operative services, intra-operative support needs, post-operative measures (medically necessary with arising complications), qualified follow-up and recovery support, pain management (post-op), and approved miscellaneous services and allowed supplies. However, complications arise in coding when evaluation and management services not covered by these global packages must be claimed separately, and in addition, there becomes the need to parcel the services of assistant surgeons, co-surgeons, and other assistant-at-surgery services rendered.
Errors found in medical coding with regard to the aforementioned procedures usually revolve around improper modifier use and inconsistent agreement in claims as far as E/M, diagnosis, procedure codes or modifiers across all of a patient’s claims history. It is imperative that all claims confirm prior data and reconcile back to any and all claims of the individual patient. Please note that also any claims of co-surgeons claiming separately must also stand in accord with the patient’s procedure claim and should utilize the same codes and modifiers.
Certified general surgery coders are proficient at navigating the complicated entanglement of codes and modifiers required to successfully and competently complete these surgical claims. The ICD-10 has increased procedure codes from the previous 11,000 to over 87,000 codes. Outsourcing surgical practice medical coding functions can augment a practice in terms of reducing the amount of claim denials, receiving inadequate reimbursement for actual services rendered, and avoiding any increased risk for audit while keeping practices in compliance across the board.