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bill 13
| Question | Answer |
|---|---|
| Separate Procedure bundled into the major procedure | If same body area during the same surgery . The more complex surgery is reorted "separate procedure" |
| two separate procedures | if performed on different body areas not bundled together reported separately |
| separate procedure bundled into the major procedure | if conducted on the same body area the lesser would be bundled into the more major procedure |
| Two separate procedures | if conducted on different body areas then the procedure is considered a separate procedure both would be reported not a minor procedure incidental to a major procedure because on different body areas |
| The surgical Package contains the components | Pre-op visits, Intra-operat services, Complications following surgery, Post op visits Supplies, misc service-dressing changes catheter removal |
| Special Report should include an adequate definition or description of the | nature, extent, and need for the procedure, and the time, effort and equipment necessary to provide the service |
| The surgery section is | the largest in the CPT manual 10004-69990 |
| Surgery is divided into subsections most are defined according to | medical Specialty or body system |
| Complex subsections are | Integumentary, Musculoskeletal, Respiratory, Cardiovascular, Digestive, and Female Genital subsections |
| The Guidelines contain | info that you will need to know in order to correctly code in the section and most of the info is not repeated elsewhere in the section |
| Guidelines are found at | the beginning of each of the CPT sections |
| The Section guidelines define terms that are necessary to | know for appropriately interpreting and reporting the procedures and services contained in the section |
| Notes may appear before | subsections, subheadings, cateogories, and subcategories |
| the information in the notes indicates the | special instructions unique to particular codes or groups of codes. The info in the notes is not usually available in the section guidelines. |
| additional information is enclosed in | parentheses, called parenthetical phrases or expressions. they sometime follow the code and provide further info about the code |
| Deleted codes are also indicated in the CPT manual enclosed in | parentheses |
| The Appendix with additions, deletions and revisions for the current year is | Appendix B |
| The Surgery Guidelines contain many unlisted | procdure codes presented by anatomical site These unlisted codes are presented in numeric order by their location in the surgery section guidelines and in the subsections by body system |
| The unlisted procedure code for procedures of the forearm or wrist is located in the surgery guidelines and also at the | end of the subheading forearm and wrist |
| The unlisted codes identify procedures or services throughtout the surgery section for which | there is no CPT code |
| If a Category III code is avaiable for the unlisted service your are reporting you must | use the category III code not the unlisted category I code Reimbursement for Category III codes will vary by payor |
| When using an unlisted procedure code to report a surgical service a | special report describing the procedure must accompany the claim |
| some procedure codes will have the words "separate procedure" after the descriptor. The term | is an indication of how the code can be assigned. Procedures followed by these words are considered minor procedures that are rported onlh when they are the only service performed or when they are performed with another major procedure different site |
| "Separate Procedure"/minor procedures are reported only when | they are the only services performed or when they are performed with another major procedure but at a different site or unrelated to the major procedure. |
| When the minor procedure is performed in conjunction with a related major procedure, the minor procedure is considered | incidental and is bundled into the code for the major procedure. |
| Third party payers have varing definitions of what consititutes a surgical package and varying policies about | what is included in the surgical package |
| Included in the definition of the surgical package are | routine preop and post op care including minor complications and up to a predefined number of days before and after surgery |
| The period of time following each surgery that is included in the surgery package is established by the | third party payer and is referred to as the global postoperative surgery period. The global period is usually 90 days for major surger and 10 days for minor surgerly |
| surgical Tray may be identified as 99070 in the | Medicine section , special services, procedures and reports subsection, miscellaneous services HCPCS A4550 reports the surgical tray also Medicare doesn't pay separterly for these kits |
| Surgical packages for procdeures usually include the | preop service, the intraoperative, related services, and routine post op services |
| Payers vary in their interpretation of the | global surgical package most follow CPT guidelines some such as Medicare expand the service that are included in the surgical package to include treaqtment of complications by teh sam physician. |
| Even though the routine follow up care is at no charge the service is still coded to indicate the service was | provided. CPT code 99024 post op fllow up visit included in global service alerts third party payer that the services were redered but included in a surgical package and not charged for. |
| Inclusion or exclusion of a procedure in the cPT manual does not imply any | health insurance coverage or reimbursement policy. Although the CPT manual includes guidelines on usage third party payers may interpret and accept the use of and the guidelins in amy manner they choose. |
| The General subsection contains codes for fine needle aspiration biopsies 10004-100211 excluding bone marrow aspirations see code 38220 The codes are divided base on | whether imaging guidance was used during the aspiration, and if so, the type of guidance performed. |
| a fine needle aspiration biopsy is used to | withdraw fluid that contains individual cells. The needle is inserted into the area being biopsied and moved several times to take multiple samples without withdrawing the needle. |
| The fluid aspirated fluidcells are then examined by a | pathologis using a microscop 88172-88173 or 88177. This type of biopsy is not a needle core biopsy |
| Needle core biopsy like code 19100 | percutaneous breat biopsy using a needle core a core of suspicious tissue is removed for examination . 19100 or the biopsy using an open incision biopsy site is exposed to the surgeons view and a sample of the lesion is removed. |
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luci2