Principles of Coding and Reimbursement for Surgeons

1. Front Matter

   Pages i-xvii

   PDF

2. Coding and Valuation

   1. Front Matter

      Pages 1-1

      PDF

   2. Medical Coding in the United States: Introduction and Historical Overview

      • Karen R. Borman

      Pages 3-11

   3. ICD-10

      • Lee R. Morisy

      Pages 13-34

   4. The CPT Code

      • Austin Ward, J. Scott Roth

      Pages 35-44

   5. A Resource-Based Relative Value Scale (RBRVS) System

      • Charles D. Mabry, Jan Nagle

      Pages 45-56

3. Reimbursement

   1. Front Matter

      Pages 57-57

      PDF

   2. CMS, the SGR, and MACRA

      • Kenneth Simon, Susan Roberts

      Pages 59-67

   3. Global Period

      • Ketan R. Sheth

      Pages 69-80

   4. Medicare Part A and DRG’s

      • John T. Preskitt

      Pages 81-93

   5. Acute Care Surgical Bundled Payment Models

      • Guy R. Orangio

      Pages 95-113

   6. Accountable Care Organizations

      • Meredith C. Mason, Nader N. Massarweh

      Pages 115-131

   7. Pay for Performance and Value-Based Care

      • Brett Tracy

      Pages 133-143

4. Specific Coding Issues

   1. Front Matter

      Pages 145-145

      PDF

   2. Coding and Reimbursement of Evaluation and Management Services

      • Mark Savarise

      Pages 147-160

   3. Skin and Soft Tissue

      • Scott Collins, Dinakar Golla

      Pages 161-175

   4. Breast Coding

      • Eric B. Whitacre

      Pages 177-185

   5. Gastrointestinal Endoscopy

      • Christopher Kim, Glenn Littenberg

      Pages 187-206

   6. Coding for Laparoscopic Surgery

      • Jennwood Chen, Eric T. Volckmann

      Pages 207-214

   7. Coding for GI Tract and Hepatopancreaticobiliary Procedures

      • Christopher K. Senkowski, Samuel Corey

      Pages 215-221

This text provides the in-depth understanding of the mechanisms that guide coding and reimbursement. The text is meant to be useful to surgeons in practice, both in general surgery and in surgical subspecialties; practice management teams of surgical practices and to resident physicians in surgery. Part 1 of the text addresses the CPT coding process, the relative valuation system (RVU), the ICD-9 and ICD-10 systems of classification, Medicare Part B payment rules for physicians, the DRG system and Medicare Part A payment for hospitals, alternative payment models, and the myriad of quality measures of importance to surgeons. Part 2 of the text addresses specific coding in areas where surgeons historically have had the most difficulty. This is not meant to substitute for the available texts, software or courses on coding, but to provide the historical background and rationale for the specific coding rules. Principles of Coding and Reimbursement for Surgeons will be of great value to general surgeons and surgical subspecialists in private practice, academic institutions, and employed positions. It will provide direction to management teams from practice and institutional levels. It is also of use to surgical trainees and to researchers in health policy issues.

• CPT
• ICD coding
• RUC
• RVU
• hospital reimbursement
• pay for performance

• Department of Surgery, University of Utah, Salt Lake City, USA

  Mark Savarise

• Department of Surgery, Mercer University School of Medicine Memorial University Medical Center, Savannah, USA

  Christopher Senkowski

Mark Savarise MD, FACS

Clinical Associate Professor of Surgery

University of Utah

30 N. Medical Drive, #3B-110

Salt Lake City, UT 84132

mark.savarise@hsc.utah.edu

Christopher K. Senkowski MD FACS

Professor and Chair

Department of Surgery

Mercer University School of Medicine

Memorial University Medical Center

Savannah, GA

Senkoch1@gmail.com

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