3D Don’t Be Obstructed By Colon Surgery handout - AAPC

10/10/2012

Don��t Be Obstructed By Colon

Surgery

Caren J Swartz, CPC�\I, CPC�\H, CPMA

Practice Integrity, LLC

Caren@

Objectives

? Understand anatomy for bowel procedures

? Understand the terms related to surgery of

bowel

? Medical Necessity and You

? ICD�\9 to ICD�\10 Are you ready??

? Gain understandingg of procedures

p

and

differences between them

? Review op notes

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Anatomy

Anatomy

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Anatomy

Right side �C ileocecal valve, ascending colon

p

flexure �C curve of large

g bowel on the

To hepatic

right side of the body, ascending to transverse.

To the Transverse Colon �C moving horizontally

across the abdomen

To the splenic flexure �C curve of the left side

attaching transverse and descending colon

Left side �C descending colon to sigmoid to

rectum and finally anus

Anatomy

3�\D lets review and answer questions

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What is mesentery??

Mesentery �C

Supporting membrane: a membrane that

supports an organ or body part, especially the

double�\layered membrane of the peritoneum

attached to the back wall of the abdominal

cavityy that supports

pp

the small and large

g intestine

Medical Necessity

Medicare defines "medical necessity" as services

or items reasonable and necessary for the

diagnosis or treatment of illness or injury or to

improve the functioning of a malformed body

member

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Medical Necessity

Consider that CMS (formerly HCFA) has the

power under the Social Security Act to

determine if the method of treating a patient in

the particular case is reasonable and necessary

on a case�\by�\case basis. Even if a service is

reasonable and necessary, coverage may be

limited if the service is provided more frequently

than allowed under a national coverage policy, a

local medical policy or a clinically accepted

standard of practice.

Medical Necessity

Consider any NCD or LCD for medical necessity.

LCD will change with regions/MAC��s

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