ICD-10 General Surgery Coding – Tips for Better Reimbursement

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ICD-10 General Surgery Coding Tips for Better
Reimbursement
ICD-10 General Surgery Coding Tips for Better
Reimbursement
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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
Comorbidity codes
Personal history codes
Overlapping sites
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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
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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

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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
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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
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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.
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