Pre-Conference Workshop - Another Day, Another Dollar: How to Improve your Billing and Coding-Surgical Billing and Coding

Surgical Billing and Coding

Pdf Summary

This comprehensive guide outlines the intricacies of the Global Surgical Package, emphasizing essential coding principles and proper documentation to ensure appropriate reimbursement for surgical services. Dr. Marc Toglia, with extensive experience in medical coding, highlights the increasing complexity of billing processes and the crucial role of coding in surgical procedures. The guide presents the three types of global surgical packages recognized by Medicare: 0-day, 10-day, and 90-day post-operative periods, each with specific inclusions regarding pre and post-operative services.<br /><br />Pre-operative services, intra-operative procedures, and post-operative care are included within the global package, and understanding these components is essential for correct billing. Proper use of surgical modifiers like -51, -59, -52, -54, and -53 is emphasized to accurately represent services rendered and override certain billing restrictions. Correct documentation practices aim to minimize denials and facilitate prompt payment.<br /><br />The guide also explains the Relative Value Unit (RVU) system, which measures the value of medical procedures, and distinguishes between what services can be billed separately using modifiers -24, -57, -78, -79, and -58 for complications or services not covered under the global package. It highlights the shared responsibility of surgeons to provide documented post-operative services that form part of the pre-paid bundle, reaffirming the importance of meticulous documentation for successful claim management.<br /><br />Additionally, the document underscores challenges such as unbundling services and maintaining awareness of changing billing regulations. It offers practical examples to demonstrate when and how separate Evaluation and Management (E&M) services might be appropriately billed alongside procedures, ensuring that surgeons remain compliant with CMS and CPT guidelines to maintain financial viability in a dynamic healthcare reimbursement environment.

Keywords

Global Surgical Package

medical coding

surgical reimbursement

Medicare post-operative periods

surgical modifiers

Relative Value Unit

billing documentation

unbundling services

Evaluation and Management

healthcare reimbursement