Chapter 18 — Further Reading

A note on how to use this list. This chapter is deliberately structural — it teaches the rules that repeat and the shape of each section, and it does not pretend to teach the cardiovascular section. The sources below are how you actually learn a section, and the honest advice is to pick the one section you will work in and go deep there rather than reading broadly across all of them.

Tier 1 — Verified canonical sources

The CPT Surgery guidelines and each subsection's guidelines, current edition. Every section in this chapter has its own guidelines, and they carry rules a general chapter cannot: the endoscopy family definitions, the maternity package's inclusions and exclusions, the hernia variables, and the laparoscopy conventions.

The CPT Anesthesia guidelines. Short, and they contain the definition of anesthesia time, the physical status modifiers, and the qualifying circumstances. §18.11 is a summary of about two pages.

The CPT moderate sedation guidelines and code descriptors. Read these rather than any summary, including this one — the unbundling changed a great deal and the intraservice time definition is precise.

CPT Assistant. Subscription. The colonoscopy family, the maternity package, and modifier 62 are recurring topics.

Medicare Physician Fee Schedule relative value file, CMS. Free. It carries all four of the columns this book has now used: global period (Ch. 17 §17.2), multiple procedure indicator (§18.8), bilateral surgery indicator (§18.9), and the professional/technical component indicator (Chapter 19 §19.1) — plus co-surgery and assistant-at-surgery indicators (§18.10). Six columns, one free file, and it answers more questions than any purchased resource in most billing offices.

Medicare Claims Processing Manual (Publication 100-04) — Chapter 12 for surgical payment rules including the multiple-procedure reduction, the bilateral methodology, and the split global package; Chapter 12's anesthesia section for the units methodology, time computation, and the provider-arrangement modifiers.

CMS guidance on medical direction requirements for anesthesia. The required steps are a defined list, and they are audited as one. If you bill anesthesia, read this document itself.

National Correct Coding Initiative Policy Manual, CMS, chapters covering the digestive, urinary, female genital, cardiovascular, and nervous systems. This is where the colonoscopy technique combinations and the pain management bundling are resolved.

Payer reimbursement policies on: bilateral reporting conventions · the multiple-procedure percentage and how many procedures are discounted · anesthesia time increments and rounding rules · physical status unit values · assistant-at-surgery eligibility · the global obstetric package and its filing deadline. Every one of these is payer-specific and every one of them appears in this chapter as a question you cannot answer from a book.

OIG Work Plan and reports on interventional pain management, colonoscopy and screening services, anesthesia services, and assistant-at-surgery billing. All four have been recurring items.

Tier 2 — Attributed, specifics unverified

Specialty society coding resources — gastroenterology, cardiology, urology, obstetrics and gynecology, neurosurgery, anesthesiology. This is the tier that actually teaches a section, and each of these societies publishes material substantially better than any general text for its own area.

Gastroenterology society guidance on the screening-to-diagnostic colonoscopy problem in particular. It is the most-written-about coding problem in the specialty and the guidance is practical.

Anesthesia billing specialty literature. Anesthesia billing is its own profession for the reasons §18.11 describes, and the specialty literature covers the payer-variation problems this chapter can only name.

Obstetric coding material on unbundling the global package, including the visit-count divisions and the transfer-of-care scenarios. Case Study 1 is the situation this literature exists for.

Published guidance on hernia repair coding, an unusually well-covered topic because the variable count is so high.

Compliance literature on claim line sequencing and practice management system configuration. Case Study 2's subject. Thinner than it should be, which is part of why the finding is as common as it is.

Tier 3 — Illustrative and constructed

All scenarios in §18.1 through §18.7, including the colonoscopy 📋 Read the Chart excerpt for Account 22-9107.

The three-procedure sequencing arithmetic in §18.8 and the anesthesia computation in §18.11.

Case Study 1 in its entirety — the obstetric practice, the job change at six months, the thirteen visits, and the split filing. Constructed; the mechanism is ordinary.

Case Study 2 in its entirety — the surgical group, the charge-capture ordering, and the supervisor's contract report. Constructed; the mechanism is arithmetic and the fix is a configuration setting.

The §18.12 both-knees counterfactual for Account 10-4471. This did not happen; the March 14 note documents a right knee injection and a normal left knee.

Three things worth doing

Open the Physician Fee Schedule relative value file and read all six indicator columns for one code you bill often. Global period, multiple procedure, bilateral, professional/technical, co-surgery, assistant-at-surgery. Six questions this book has raised, answered by six columns, in a free file, and most coders have opened it zero times.

Then read your two largest payers' policies on the multiple-procedure percentage and on bilateral reporting. Twenty minutes each. Chapter 14's Case Study 2 was four years of not doing the second one.

And check the order of your claim lines. Take one multi-procedure claim, look at the submitted claim, and confirm the highest-valued procedure is on line 1. Then confirm on the remittance that the reduction was applied to the right lines. Case Study 2 is an afternoon, a configuration setting, and possibly more money than any coding change you will make this year.