ICD-10 General Surgery Coding – Tips for Better Reimbursement

1. ICD-10 General Surgery Coding – Tips for Better Reimbursement ICD-10 General Surgery Coding – Tips for Better Reimbursement www.outsourcestrategies.com

2. The medical coding team at every physician practice should stay updated with general surgery coding and reimbursement changes to avoid claim denials and safeguard practice revenue.The American College of Surgeons has pointed out some areas, where general surgery practices and departments of surgery can improve their ICD-10 coding and documentation. The areas include: Specificity and laterality Comorbiditycodes Personal history codes Overlapping sites www.outsourcestrategies.com

3. Specificity and laterality • With the end of the ICD-10 grace period, now unspecified codes and lack of laterality may result in lower reimbursement and rejected claims. Specific details are an important component when documenting a medical record. Examples: While documenting conditions, make sure to provide specific details. Breast Cancer • C50.511 – Malignant neoplasm of lower-outer quadrant of right female breast • C50.512 - Malignant neoplasm of lower-outer quadrant of left female breast • C50.821 - Malignant neoplasm of overlapping sites of right male breast • C50.822 - Malignant neoplasm of overlapping sites of left male breast Benign neoplasm • D12.2 - Benign neoplasm of ascending colon • D12.3 - Benign neoplasm of transverse colon • D12.4 - Benign neoplasm of descending colon • D12.5 - Benign neoplasm of sigmoid colon www.outsourcestrategies.com

4. Comorbidity codes • It is now very important to code for co-morbidities, especially those that potentially affect patient care. Failing to go beyond the primary diagnosis would result in reduced reimbursements. Co-morbidity codes could help establish medical necessity. Examples: Transurethral prostatectomy – Comorbidities • Diabetes • Arteriosclerotic heart disease • Emphysema www.outsourcestrategies.com

5. Personal history codes • Documenting personal and family history codes are relevant to better patient treatment. This also helps in accurate medical coding, thus increasing reimbursement and preventing claim rejections. Examples: Categories Z85-Z99 - personal history codes • Z85 – Personal history of malignant neoplasm • Z86 – Personal history of certain other diseases Categories Z80 to Z84 - family history codes • Z80 – Family history of primary malignant neoplasm • Z81 - Family history of mental and behavioral disorders www.outsourcestrategies.com

6. Overlapping sites • In the case of neoplasms, remember to use overlapping lesion codes instead of codes for each specific area. Examples: Colorectal neoplasms • C18.8 - malignant neoplasm of overlapping sites of colon Neoplasms of pancreas • C25.8 - malignant neoplasm of overlapping sites of pancreas www.outsourcestrategies.com

7. Professional medical billing and coding companies provide the service of skilled AAPC-certified coders, who are up-to-date with all the critical changes taking place in the coding landscape. The advanced training they undergo helps them stay updated with the new and revised codes, know when to apply the correct modifier, and thus reduce medical claim denials for your general surgery practice. www.outsourcestrategies.com

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