Description
This week for your discussion, please research a procedure in one of Surgery sections we are studying–Digestive, Urinary, Genital, Pregnancy, Nervous, Eye or Ears. You may use any source you deem reliable, but you will need to give the source in your post.
- For your initial post, summarize the treatment you chose in at least a full paragraph. Be sure to include why the procedure is done, as well as how the procedure is completed. Please remember to include the source of your information.
Examples: Digestive System
- Note the definitions of proctosigmoidoscopy, sigmoidoscopy, and colonoscopy in the text. In general, sigmoidoscopy procedures are done without anesthesia of any kind. Colonoscopies require some type of sedation to avoid severe discomfort for the patient. Knowing this fact may help determine exactly which procedure has been performed if the physician is unclear in his or her documentation.
- Full-thickness laceration repairs of the lip are coded in this section rather than in the integumentary section. For simple and intermediate repair of the skin on the lip, refer to the integumentary section.
- Cancer screening codes (G0102-G0106 and G0120-G0122) should be reviewed for use when coding Medicare patients.
Urinary
Review the anatomy of the urinary system. Remember that there are two ureters (one from each kidney) and one urethra (to the outside of the body). Care must be taken to read operative notes and codes carefully to be sure the correct anatomy is being referenced. It is very easy to confuse these two structures.
Male/Female Genital Systems
- Destruction of lesions on the skin of the male and female genital organs is found in these sections, not in the integumentary system. Definitions for the female system are at the front of this section in the CPT codebook.
- The vasectomy code (55250) is unilateral or bilateral and the -50 modifier is not used for this procedure.
- Though it may seem unusual, some obstetricians perform the circumcision on male newborns. Some pediatricians do not feel comfortable performing the procedure and third-party payers may not pay for the circumcision and a newborn exam on the same day. Therefore, the OBs may perform the procedure.
- Vaginal and laparoscopic hysterectomy codes are divided further, one with a uterus of 250 g or less and another with a uterus of greater than 250 g.
Maternity Care and Delivery
Maternity care is usually billed as a complete package of antepartum care, delivery services, and postpartum care. There are different packages based on the type of delivery that is necessary. The CPT codebook has definitions of this package concept at the beginning of the maternity care and delivery section.
Remember that we need to use bundled codes whenever possible!
