General Surgery Coding Alert

Earn an extra $1,000 by coding the correct approach Adding a single -extra- procedure during a variety of gastrointestinal surgeries can make a huge difference in your reimbursement dollars. When examining op notes, here are four examples of gastro surgeries that you should pay special attention to. 1. Watch for Pouch With Rectum Removal If you find yourself reaching for new-for-2006 code 45395 (Laparoscopy,  surgical; proctectomy, complete, combined abdominoperineal, with colostomy), research a bit further to be sure you shouldn't assign 45397 (... proctectomy, combined abdominoperineal pull-through procedure [e.g., colo-anal anastomosis], with creation of colonic reservoir [e.g., J-pouch], with diverting enterostomy, when performed) for pouch creation instead. Code 45395 pays 47.83 relative value units (RVUs) in a facility setting, while 45397 reimburses 51.96 RVUs--a difference of about $150,  on average.

Tip: The surgeon may not explicitly state that he created a pouch, but he might list the types of staplers he used, and in which order, says M. Trayser Dunaway, MD, FACS, CSP, CHCO, CHCC, a surgeon, physician and coding educator, and healthcare consultant in Camden, S.C. This could be a tip-off to you that he performed something more than lap removal of the rectum.

For instance: A laparoscopic surgeon may use a GIA stapler to make the pouch and an end-to-end anastomosing stapler to attach it. If you see documentation of this type, you might be looking at a 45397 claim instead of 45395.

Take the time to ask: If you think the documentation is unclear, don't hesitate to ask the surgeon exactly what he did. You don't want to give up reimbursement dollars, but neither should you report procedures that the documentation cannot support. 2. Approach Makes All the Difference Pay attention to whether your surgeon repairs an ileoanal pouch fistula via the transperineal approach (46710, Repair of ileoanal pouch fistula/sinus [e.g., perineal or vaginal], pouch advancement; transperineal approach) or a combined transperineal-transabdominal approach (46712, -combined transperineal and transabdominal approach). The -double- approach pays 52.74 RVUs instead of just 25.15 RVUs in the facility setting (a difference of about $1,000).

-During the description of the prep, if the surgeon states the -abdomen- was prepped, along with the perineum, that's a tip-off of where incisions may be placed- [meaning a combined approach], Dunaway says. -Then during the operation, pay attention to where the incisions actually occur. Sometimes, the surgeon will prep both areas but may use different incisions depending on the information that becomes available during exploration.- 3. Sigmoid Resection Adds to Proctopexy The addition of sigmoid resection 45402 (Laparoscopy, surgical; proctopexy [for prolapse], with sigmoid resection) with laparoscopic proctopexy (45400) can mean a more than $350 difference in reimbursement (37.86 RVUs for 45402 vs. 27.93 RVUs for 45400), so you don't want [...]