Discussion Question
1. You perform a laparoscopic appendectomy on a 25 year old male in the OR of the hospital where you practice. The procedure is uncomplicated and you send the patient a bill for your services a. What is the proper CPT code for this service? b. Do you need to use a modifier to properly describe this service? If so, which one? c. How many total RVU’s does this represent?
2. You are called to the operating room by the gynecologists to remove a diseased gall bladder they discovered during a hysterectomy. You perform the procedure and follow the patient postoperatively for several visits. a. What is the proper CPT code for this service? b. Do you need to use a modifier to properly describe this service? If so, which one?
3. You do an exploratory laparotomy for a gunshot wound to the abdomen. You perform a primary repair of the small bowel, a small bowel resection, and do a primary repair of the inferior vena cava. a. What is (are) the proper CPT code(s) for this service? b. Do you need to use a modifier(s) to properly describe this service? If so, which one?
4. You perform a left hemicolectomy for colon cancer. During the procedure, you find that the patient has extensive adhesions from previous surgery. You spend two hours taking down adhesions before performing the colectomy. In order to perform a tension free anastomosis, you take down the splenic flexure of the colon. a. What is the proper CPT code for this service? b. Do you need to use a modifier(s) to properly describe this service? If so, which one?
5. You place a subclavian triple lumen central venous line for TPN in the ICU. The subsequent chest film reveals a pneumothorax and that the line travels up the internal jugular vein rather than into the superior vena cava. You place a chest tube and then successfully change the first central line over a wire. a. What are the proper CPT codes for these services?

b. Do you need a modifier(s) to properly describe these services?
6. You are working at Bellevue hospital in Manhattan NYC. A 75 year old male patient presents with perforated sigmoid diverticulitis. You perform an uncomplicated
Hartmann’s Procedure (sigmoid resection with end sigmoid colostomy and oversewing of the rectal stump) and follow the patient postoperatively. The patient’s primary payor is
Medicare. What is the proper CPT code for this procedure? How much will you be reimbursed for this procedure?
Work RVU’s:
Non facility Practice Expense RVU’s:
Facility Practice Expense RVU’s:
Professional Liability Insurance RVU’s:
2012 Medicare Conversion Factor:
27.79
15.72
15.72
5.74
$34.0376
7. You, a junior resident on the trauma service at MUSC, repair of a 6 cm laceration of the left forearm with a single layer of nylon sutures. The attending surgeon is in the trauma bay while you perform the procedure. The patient is covered by Medicare.
What is the proper CPT code for this service?
How much will the attending be paid for this service?
Work RVU’s:
Non facility Practice Expense RVU’s:
Facility Practice Expense RVU’s:
Professional Liability Insurance RVU’s:
2012 Medicare Conversion Factor:
1.14
1.95
0.57
0.19
$34.0376
How much will the attending surgeon be paid if he is sleeping in the call room on the 7 th floor while you perform the repair?
What if the attending was covered by Medicaid and the attending was in the ICU flirting with the nurses while you did the procedure? Would the attending be paid for the procedure by Medicaid?

Locality Name
Alabama
Alaska
Arizona
Arkansas
Anaheim/Santa Ana, CA
Los Angeles, CA
Marin/Napa/Solano, CA
Oakland/Berkley, CA
San Francisco, CA
San Mateo, CA
Santa Clara, CA
Ventura, CA
Rest of California
Colorado
Connecticut
DC + MD/VA Suburbs
Delaware
Fort Lauderdale, FL
Miami, FL
Rest of Florida
Atlanta, GA
Rest of Georgia
Hawaii/Guam
Idaho
Chicago, IL
East St. Louis, IL
Suburban Chicago, IL
Rest of Illinois
Indiana
Iowa
Kansas
Kentucky
New Orleans, LA
Rest of Louisiana
Southern Maine
Rest of Maine
Baltimore/Surr. Cntys, MD
0.974
1.028
0.988
1.021
0.976
0.978
0.962
1.048
1.012
0.992
0.998
0.978
1.006
0.978
0.999
Work RVU's
0.979
1.5
0.983
0.964
1.039
1.039
1.042
1.055
1.065
1.072
1.08
1.03
1.016
0.991
1.031
0.966
0.971
0.985
0.969
0.982
0.964
1.019
0.943
1.062
0.962
1.056
0.941
0.957
0.934
1.218
1.041
1.041
1.072
0.976
1.006
0.943
1.198
Practice Expense
RVU's
0.928
1.092
0.983
0.923
1.271
1.22
1.272
1.286
1.422
1.418
1.31
1.251
1.078
0.997
1.168
0.939
0.932
1.018
0.936
1.029
0.947
1.084
0.572
2.005
1.851
1.665
1.274
0.603
0.443
1.081
0.678
2.112
2.984
1.635
0.89
0.876
0.685
Professional Liability
Insurance RVU's
0.484
0.648
0.913
0.444
0.742
0.722
0.443
0.469
0.464
0.454
0.445
0.684
0.546
0.754
1.102
0.746
0.701
0.933
0.816
0.584
0.584
1.147

Rest of Maryland
Metropolitan Boston
Rest of Massachusetts
Detroit, MI
Rest of Michigan
Minnesota
Mississippi
Metropolitan Kansas City, MO
Metropolitan St. Louis, MO
Rest of Missouri
Montana
Nebraska
Nevada
New Hampshire
Northern NJ
Rest of New Jersey
New Mexico
Manhattan, NY
NYC Suburbs/Long I., NY
Poughkpsie/N NYC Suburbs, NY
Queens, NY
Rest of New York
North Carolina
North Dakota
Ohio
Oklahoma
Portland, OR
Rest of Oregon
Metropolitan Philadelphia, PA
Rest of Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Austin, TX
Beaumont, TX
Brazoria, TX
Dallas, TX
Fort Worth, TX
Galveston, TX
Houston, TX
Rest of Texas
0.996
0.96
1.003
0.974
1.015
0.99
0.907
1.015
1.031
0.981
1.063
1.05
1.013
1.047
0.993
0.972
0.957
0.986
0.992
0.953
0.948
0.964
0.999
0.987
1.051
1.002
1.021
1.01
1.029
0.995
0.995
0.961
0.976
0.946
0.976
0.988
0.978
1.014
1.009
0.99
1
1.012
0.974
0.961
0.927
1.016
0.968
1.084
0.958
0.845
1.071
1.125
0.947
1.263
1.278
1.074
1.233
0.964
0.96
1
0.973
0.968
0.913
1
0.943
1.042
1.046
1.206
1.013
1.238
1.1
1.026
0.96
0.994
0.929
0.952
1
0.945
0.995
0.937
0.967
1.001
0.982
0.985
0.992
0.943
1.23
0.671
0.542
0.542
1.619
1.101
0.249
1.089
1.077
1.054
1.137
1.335
0.945
1.351
0.492
0.664
0.453
1.204
1.064
1.004
0.887
0.28
1.149
0.658
1.077
0.93
0.776
0.776
1.855
1.075
0.262
0.782
0.482
0.424
0.566
0.859
1.131
1.07
0.969
0.966
1.1
1.131
0.936

Utah
Vermont
Virginia
Virgin Islands
Seattle (King Cnty), WA
Rest of Washington
West Virginia
Wisconsin
Wyoming
0.975
0.973
0.988
0.998
1.02
0.991
0.968
0.988
0.964
0.953
1.002
0.978
0.994
1.098
0.991
0.912
0.966
1
1.059
0.523
0.692
1.007
0.785
0.77
1.279
0.476
1.052

22 Unusual Procedural Services
50 Bilateral Procedures
51 Multiple Procedures
52 Reduced Services
53 Discontinued Procedure
54 Surgical Care Only
58 Staged or Related Procedure or Service by the Same Physician During the
Postoperative Period
59 Distinct Procedural Service
62 Two Surgeons
63 Procedure Performed on Infants less than 4 kg.
66 Surgical Team
76 Repeat Procedure by Same Physician
77 Repeat Procedure by Another Physician
78 Return to the Operating Room for a Related Procedure During the Postoperative
Period
79 Unrelated Procedure or Service by the Same Physician During the Postoperative
Period