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Billing

  • R. Lawrence ReedII
Chapter

Abstract

Surgical critical care requires a sound understanding of documentation, coding, and billing rules in order to ensure a successful practice. Trauma and acute care surgery patients often require critical care services in the acute and/or perioperative period. Because of global surgical package rules, however, there is a significant degree of confusion regarding which procedures and services can be legitimately billed on patients during the perioperative period. In many cases, surgeons fail to take advantage of the legitimate opportunities for reimbursement in these patients, primarily due to their lack of understanding or misunderstanding of those rules. Moreover, failing to learn and understand the rules usually leads to significant financial losses or, potentially, to illegitimate practices that could have significant legal consequences. Generally speaking, more opportunities exist in more complex patients because of the additional conditions that need management and the multiple procedures that may be required to manage the patient. Knowing the rules for critical care evaluation and management (E&M) and documentation and coding is essential for an effective critical care program. In addition a firm understanding of the global package rules and their impact on documentation and billing is important, as many bedside procedures actually have a global package period, which may be as short as the single day on which the procedure was performed.

Keywords

Coding Billing Relative value unit Modifier Current procedural terminology 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Revenue Cycle Services, IU Heatlh, Department of Surgery, IU Health Methodist HospitalIndianapolisUSA

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