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Format: On-Demand Webinar
Presenter: Jan Rasmussen, PCS, ACS-OB, ACS-GI
Time: You can access the webinar anytime
Duration: 60 minutes
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The Global Surgical Package has been around for many years in the CPT book. In 1992 when CMS introduced the Resource-Based Relative Value Scale (RBRVS) the concept of global surgery was significantly changed for services reported to the Center for Medicare and Medicaid (CMS), The AMA and CMS continue to have different concepts related to the surgical package. If you are relatively new to coding for surgical services this program will give you a solid foundation for reporting surgical services. If you have been reporting surgical services for several years this program will provide a good review of the global surgical concepts. It may even refresh some concepts that have been forgotten over time.

Learning Objectives:

  • Explain the components of the global surgical package
  • Understand the differences between the CPT and Medicare guidelines for surgical services
  • Know the guidelines for preoperative care
  • Define the meaning of a separate procedure and its significance in reporting multiple services on the same day.
  • Explain the Correct Coding Initiative and the concept of unbundled services
  • Know the rules for reporting endoscopic and open procedures at the same session
  • Understand correct reporting for lysis of adhesions
  • Explain the concept of split care reporting for surgical services
  • Correctly report services when one physician does not perform all the components of the surgical global package

Areas Covered in the Session

  • Compliance & Standards
  • Explanation of Benefit (EOB)
  • AMA Global Package
  • CMS’S Global Surgical Package
  • Preoperative Services
    • Z01.810 – Preprocedural cardiovascular examination
    • Z01.811 – Preprocedural respiratory examination
    • Z01.812 – Preprocedural laboratory examination
    • Z01.818 – Other preprocedural examination
  • AMA Versus CMS: Global Package Comparison
  • Care for Underlying Condition
  • Complications Issue
  • Complication Examples
    • 10180- Incision and drainage, complex, postoperative wound infection
    • 57022- Incision and drainage of vaginal hematoma; obstetrical/postpartum
    • 11042- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
  • Modifier -24 Issues
  • CPT Definition
  • CMS policy
  • Definition of Unrelated
    • Anesthesia Issue
    • Office Surgical Trays
    • Failed Procedures
    • Intra-Operative Complications
    • Lysis of Adhesions
    • Postoperative Pain Management
    • Services Not Included
    • CMS Minor Procedure Guidelines
  • Modifier -25
    • CPT Definition
    • CMS’s Interpretation §4821.C
    • No different diagnosis according to the AMA and CMS guidelines
  • Scope Guidelines
    • General Endoscopic Guidelines
    • Endoscopic Payment Example
  • Unbundling & Correct Coding Initiative
    • Unbundling
    • Unbundling Tips
    • Correct Coding Initiative
    • CCI General Bundling Concepts
    • Generic Services Included
  • General Bundling Concepts
    • Biopsy as a part of the Procedure
    • Exploratory Surgery
    • Access Through Abnormal Tissues
    • Excision and Incision
    • Multiple Approaches
    • Endoscopies
    • Primary Procedure Complications
    • Sequential Procedures
  • Checking Work Versus Diagnostic Procedures
  • Conclusions
  • Major versus minor procedure reporting
  • Explanation of global surgery billing
  • Explanation of “separate procedure”
  • Decision for surgery

Suggested Attendees

  • Surgical coders
  • Surgeons
  • Surgical practice office managers
  • Denial staff
  • Primary care performing preoperative care for surgeons
  • Providers
  • Coders
  • Clinic managers
  • Denial management staff
  • Accounts payable staff
  • Auditors
  • Office Managers
  • Denial resolution teams
  • Insurance payers
  • Payment policymakers
  • Billing Staff
  • Coding Staff
  • Compliance officers
  • Physician and Non-physician Practitioners
  • Insurance Company Claims Reviewers

About the Presenter

Jan Rasmussen, PCS, ACS-OB, ACS-GI, – As a healthcare consultant Jan has more than 35 years of experience in physician billing, reimbursement, and compliance. Jan is currently the owner of Professional Coding Solutions, a healthcare consulting firm. She has been a Certified Professional Coder (CPC) since 1992 with active membership in the American Academy of Procedural Coders (AAPC). As a member of the AAPC, Jan previously served on their Advisory Board as the liaison to the AMA, has been a speaker for the AAPC annual conference as well as contributing to the development of AAPC’s independent study and university education programs and proficiency tests. In 1994, she was honored by AAPC as Networker of the Year. Jan was also a Regional Governor for the American College of Medical Coding Specialists (ACMCS) serving as Chair of the Ethics committee and a member of the Examination committee.

In her role as a physician consultant, she has participated in physician coding and documentation reviews including OIG government PATH and Campus audits, and designed and conducted physician coding seminars nationwide. She has been a guest speaker for several conferences sponsored by United Communications, Inc//Decision Health, AAPC as well as Coding Institute Specialty Conferences.

In previous consulting positions, she was responsible for developing and conducting seminars for basic, intermediate, and advanced ICD-9-CM and CPT, teaching physician guidelines as well as special seminars for OB/Gyn, Orthopedics, Urology, Gastroenterology, General Surgery, ENT, Cardiology, Emergency Medicine and Evaluation and Management. In her role as an educator, she has been teaching E/M documentation and auditing to both physician and coding audiences since 1992 when RBRVS was first implemented.

Jan has also worked for several major health insurance payers in Wisconsin, was a coding advisor to the WPS Medicare Carrier Advisory Committee, and served as the coding and reimbursement coordinator for a 37-provider, staff model HMO clinic. As the coding and reimbursement coordinator, Jan was responsible for physician office, hospital, surgical, and nursing facility coding charge ticket development, fee development, reimbursement analysis, claims analysis, and physician education.

Course Content

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