General Surgery Billing: Tips, Codes, & Common Errors
Ultimate Guide to General Surgery Billing: Best Practices & Common Mistakes
Understanding General Surgery Billing
ICD-10-CM Diagnosis Codes for General Surgery Billing
Y83.9: Used to indicate an abnormal reaction or complication due to a surgical procedure without specifying a misadventure during the procedure. Effective October 1, 2023.
Y83: Applies to abnormal reactions or complications from a surgical operation or procedure, excluding misadventures.
Y84: Used when another medical procedure causes an abnormal reaction or complication without mentioning misadventures.
T81.320-: Indicates disruption or dehiscence of a gastrointestinal tract anastomosis, repair, or closure.
T81.321-: Specifies disruption or dehiscence of the closure of an internal operation wound of the abdominal wall muscle or fascia.
T81.328-: Used for disruption or dehiscence of the closure of another specified internal operation wound.
T81.329-: Covers deep disruption or dehiscence of an unspecified operation wound.
G20: Formerly used for Parkinson’s disease but now a parent code effective October 1, 2024. The new codes G20.A, G20.A1, G20.A2, and G20.B should be used for specific types of Parkinson’s disease.
General Surgery CPT Codes
Evaluation and Management Codes (99201-99499):
Procedures in Surgery (10021-69990):
Includes various surgical techniques, such as:
- 10021: Biopsy using a fine needle without imaging guidance.
- 20610: Aspiration or injection of a large joint or bursa.
- 43235: Biopsy and upper gastrointestinal endoscopy.
Debridement Codes (11000-11983):
For procedures involving the removal of diseased, damaged, or infected tissue:
- 11042: Debridement of the first 20 square centimeters or less of subcutaneous tissue.
- 11721: Debridement of one to five nails.
Procedures of the Musculoskeletal System (20100-29999):
Covers joint surgeries, bone grafts, and fracture repairs:
- 23120: Partial removal of a bone (e.g., tibia or fibula).
- 27244: Total hip replacement surgery.
Procedures for the Respiratory System (30000-39999):
Includes lung resections and bronchoscopy:
- 31624: Bronchoscopy with or without fluoroscopic guidance.
- 32656: Surgical thoracoscopy with diagnostic lung biopsy.
Procedures for the Cardiovascular System (40000-49999):
Encompasses cardiovascular interventions such as angioplasty and pacemaker installation:
- 42820: Modification of the pacemaker skin pocket.
- 37221: Endovascular revascularization of the iliac artery.
Procedures for the Genitourinary System (50010-53899):
Includes surgeries related to the kidneys, bladder, and urethra:
- 50590: Ureteroscopy with catheterization and biopsy.
- 52281: Fulgration of bladder or prostatic tissues.
Procedures for the Digestive System (54000-58999):
Covers gastrointestinal surgeries, hernia repairs, and gallbladder removal:
- 54050: Orchiopexy with or without hernia repair.
- 47562: Laparoscopic cholecystectomy with cholangiography.
Procedures of the Female Genital System (60000-60699):
Includes surgeries on the female reproductive organs:
- 58100: Hysterectomy with or without removal of the tubes or ovaries.
- 58970: Treatment for enterocele.
Procedures of the Male Genital System (61000-64999):
Covers procedures related to male reproductive health:
- 62140: Orchidectomy for testicular torsion.
- 55866: Vasovasostomy.
Procedures for the Endocrine System (65069-68899):
Encompasses surgeries of the thyroid, parathyroid, and adrenal glands:
60220: Thyrotoxic lobectomy.
60500: Parathyroid autotransplantation.
Nervous System Operations (70000-79999):
Includes procedures on the nervous system, such as brain surgery and spinal operations:
- 61510: Craniectomy or craniotomy for brain tumor removal.
- 63047: Lumbar laminectomy for lesion excision.
Cardiovascular Procedures (92920-93799):
Covers cardiac interventions like angiograms and stent placements:
- 93458: Right heart coronary angiography.
- 92928: Coronary artery angioplasty.
Nuclear Medicine Procedures (93922-94799):
Involves radiological methods used in surgery:
- 93970: Duplex scan of abdominal or pelvic vessels.
- 76645: Ultrasound of the breast.
Allergy and Immunology Procedures (95004-95199):
Includes allergy testing and immunotherapy:
- 95004: Percutaneous allergy testing.
- 95165: Preparation and supply of allergy immunotherapy.
Administration of Therapeutic, Chemotherapy, and Hydration (96360-96549):
For delivering chemotherapy and intravenous therapies:
- 96361: Hydration by intravenous infusion per extra hour.
- 96413: Chemotherapy infusion, up to one hour.
Reports, Procedures, and Special Services (99000-99099):
Covers unique services and reporting:
- 99000: Transport of a specimen to a lab.
- 99080: Special reports, including insurance forms.
Common Mistakes in General Surgery Billing.
- Incorrect Coding: Misclassifying procedures or using outdated codes can result in claim rejections or delays.
- Incomplete Documentation: Failing to provide thorough and accurate documentation can lead to insufficient support for claims and subsequent denials.
- Misapplication of Modifiers: Using incorrect or inappropriate modifiers can alter the reimbursement amount or result in claim denials.
- Failure to Verify Insurance Coverage: Not confirming patient insurance details before procedures can lead to issues with coverage and payment.
- Omitting Necessary Documentation: Missing required details, such as operative reports or patient consent forms, can compromise the claim’s validity and processing speed.
Closing Note
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