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1 December 2011, Vol. 13, No. 12 (Pages 81-88)2011 Call us: 1-877-912-1691 The coding institute , LLC 2222 Sedwick Drive, Durham, NC 27713 General Surgery coding AlertYour practical adviser for ethically optimizing coding , payment, and efficiency in general surgery practicesIn this issueICD-10 Switch from to for Peritoneal Abscess p82 Little changes from ICD-9 to ICD-10 for this 201299218-99220: Observation Time Guidelines Could Help You Gain Pay p83 Also watch for modifier Necessity3 Steps Focus Diagnosis coding for Your Surgical Claims p84 Add these tips to your ICD-9 Be the Coder p85 Anatomy Answers Cecectomy Question Reader Questions49321: Stick to Anatomic Site for Code Selection p86 Know GC Rules for Resident Surgical Assists p8610021/21011 Bundles Limit coding p87 Use Inclusive Code for Whipple Resection p87 CPT 2012 }49082-49084 Separate Peritoneal Procedures for More Accurate CodingGet ready for vascular and skin changes, too.

2 Have you ever been baffled trying to distinguish between an acellular dermal replacement and an acellular dermal allograft? You ll wonder no more, now that CPT 2012 scraps six families of codes in favor of one new skin-substitute-graft ve got a look at these changes and more, so read on for tips on how to code your general surgery claims in Paracentesis, LavagePrior to , 2012, abdominal paracentesis and peritoneal lavage shared codes meaning that you couldn t distinguish which procedure your surgeon actually performed. Plus, you needed to know whether your surgeon was performing an initial service or a subsequent peritoneal procedure, a fact that was often difficult to ascertain from the surgeon s op note. CPT 2012 changes all that by deleting the following codes:49080 Peritoneocentisis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial49081.

3 Subsequent,and replacing them with the following new codes:49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance49083 .. with imaging guidance49084 Peritoneal lavage, including imaging guidance, when performed. You ll use one of these new codes when your surgeon diagnoses or treats a patient with accumulated peritoneal fluid or possible internal bleeding, explains Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, manager of compliance education for the University of Washington Physicians Compliance Program in is different: Remember to use 49084 only for percutaneous lavage, Bucknam says. For open lavage, report 49000 (Exploratory laparotomy, exploratory celiotomy with or without biopsy[s] [separate procedure]) or 49002 (Reopening of recent laparotomy).

4 For laparoscopic lavage, report 49320 (Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen[s] by brushing or washing [separate procedure]). Don t miss: Lavage is bundled into exploration except when performed percutaneously. This is a common mistake and costs general surgery practices thousands of dollars in lost revenue, Bucknam says. The coding institute SPECIALTY ; Inspired by Coders, Powered by coding ExpertsThe coding institute SPECIALTY ALERTSCall us: 1-877-912-1691 The coding institute , LLC 2222 Sedwick Drive, Durham, NC 27713p82 SPECIALTY specific codesets, tools and content on one page in Call 1-866-228-9252 now for a super deal!Check Out New Skin Substitute CodesIf you ve ever reported your surgeon s skin-substitute grafting, you know how confusing it is to match the skin-substitute product to the proper code family descriptor.

5 Starting Jan. 1, you ll no longer need to figure out which family describes which skin-substitute product, because CPT 2012 deletes the following six code families:15170-+15176 Acellular dermal replacement ..15300-+15321 Allograft skin for temporary wound closure .. 15330-+15336 Acellular dermal allograft .. 15340-+15341 Tissue cultured allogeneic skin substitute .. 15360-+15366 Tissue cultured allogeneic dermal substitute ..15400-+15421 Xenograft skin [dermal] for temporary wound closure ..15430-+15431 Acellular xenograft implant .. Editorial advisory BoardGary W. Barone, MDAssociate Professor of Surgery University of Arkansas for Medical Sciences, Little Rock Suzan Berman, CPC, CEMC, CEDCS enior Manager of coding Education and Documentation Compliance, Physician Services Division, Pittsburgh Medical Center Pittsburgh, PennJohn Bishop, PA-C, CPCP resident Bishop & Associates, Inc.

6 Tampa, FloridaJudy Breuker, CPC, CCS-P, CHCCCEO, Medical Education Services LLC, Mich. Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCCP resident, CRN Healthcare Solutions Tinton Falls, L. Conklin, CPC Independent coding Consultant Wesley Chapel, Fla. Ian S. Easton, PhD, FACMPEPast President, American College of Medical Practice Executives Department Head-Applied Technology, Coastal Georgia College, A. Fletcher, BS, CPC, CCS-P, CCSH ealthcare coding Consultant President/CEO, Terry Fletcher Consultants, Calif. Member, American Academy of Professional CodersArlene Morrow, CPC, CMMP resident, AM Associates, Fla. Seminar Leader, McVey AssociatesKathleen Mueller, RN, CPC, CCS-PHealthcare Consultant, Lynn Reading, RN, BS CEO, Ceder Edge Medical coding and Reimbursement, Santana, RHIT, CCS, CCS-P, CPCP resident, Quest for Quality coding Inc.

7 Troy, L. Turney, MD, FACPM edical Director Reimbursement Marshfield Clinic, Wis. ICD-10 }Switch from to for Peritoneal AbscessLittle changes from ICD-9 to ICD-10 for this surgeon may diagnose a peritoneal abscess when a procedure such as abdominal paracentesis confirms a pocket of infected fluid and pus within the abdominal cavity. That s when you ll turn to (Peritoneal abscess) to describe the diagnosis. But when ICD-9 shifts to ICD-10 on Oct. 1, 2013, you ll need to report the condition with (Peritoneal abscess).Code cause, if known: The condition is often caused by a ruptured appendix, ruptured intestinal diverticulum, inflammatory bowel disease, or parasitic infection in the intestines. You should also code those conditions, if documented.

8 Although an abdominal CT scan will often uncover the abscess, your surgeon may perform a paracentesis procedure or peritoneal lavage to confirm the diagnosis. Documentation: Take note of other similar terms that the physician could use when describing peritoneal abscess. is also applicable to abdominopelvic abscess, abscess (of) omentum, abscess (of) peritoneum, mesenteric abscess, retrocecal abscess, subdiaphragmatic abscess, subhepatic abscess, and subphrenic abscess. qGeneral Surgery coding alert (USPS # 019-299) (ISSN 1526-0356 for print; ISSN 1947-8720 for online) is published monthly 12 times per year by The coding institute , LLC 2222 Sedwick Drive, Durham, NC 27713. 2011 The coding institute . All rights reserved. Subscription price is $249.

9 Periodicals postage is paid at Durham, NC 27705 and additional entry : Send address changes to General Surgery coding alert , 2222 Sedwick Drive, Durham, NC 27713 Call us: 1-877-912-1691 The coding institute , LLC 2222 Sedwick Drive, Durham, NC 27713 The coding institute SPECIALTY ALERTSS pecialty specific codesets, tools and content on one page in Call 1-866-228-9252 now for a super deal! p83 Instead, you ll choose the appropriate code based on graft location and size using one of the following new CPT 2012 codes:15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq. cm; first 25 sq. cm or less wound surface area +15272 .. each additional 25 sq. cm wound surface area or part thereof (List separately in addition to code for primary procedure) 15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq.

10 Cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children +15274 .. each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq. cm; first 25 cm or less wound surface area +15276 .. each additional 25 sq. cm wound surface area, or part thereof (List separately in addition to code for primary procedure) 15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq.