1. Obtain correct physician documentation. Obtain full documentation for spine procedures, operative notes, anesthesia and medication list before you begin coding.
"You have to make sure all is in order before starting to code," says Ms. Talton. "There are several challenges, especially when we have more than one procedure. We have to ensure we are assigning the level of specificity for any spine procedure and the correct modifiers. Claims can be denied because modifiers are not affixed to the second tertiary procedure. That can be very costly and time consuming from a revenue cycle point of view."
This documentation will become even more specific after the transition to ICD-10 in October 2014. Surgery centers can provide physician education courses to make sure they are ready for the transition.
"Physician education is going to be critical during the upcoming days, weeks and months leading up to ICD-10 conversion," says Ms. Talton. "Physicians need to be made very aware of how they are noting procedures. They need to be very specific and aware of how they are wording their reports to avoid ambiguity in their operative findings. I suspect there will be physician queries when the operative notes are not clear, so if there is an opportunity for physician education, start now and continue through implementation. Otherwise, there is a huge drop in reimbursement because of that."
2. Code for add-ons when possible, but don't unbundle. Coders often miss opportunities to include add-on codes, especially with spine surgery. When procedures are performed on one level followed by a subsequent procedure, you can use an add-on code.
"The correct way to code multiple procedures is to code the first procedure and use an add-on for the second," says Ms. Talton. "However, they must be careful not to unbundle or bundle CPT codes because that's an unethical procedure."
Avoid unbundling if there are incidental services in the surgical package reported, which are included within the main procedure. "They should check each procedure code with CPT bundling edits and pay attention to CPT guidelines when they are coding," says Ms. Talton. "Query the physician to make sure the second procedure wasn't included in the main procedure."
3. Employing modifiers. There are a few spine cases that can be billed with modifiers. Coders must know when to use modifiers appropriately.
"If the second procedure was done in a separate area with a separate incision, then it could be separately billable," says Ms. Talton. "Otherwise, it's part of the main procedure. I would encourage coders to check the operative notes and procedure book carefully before using additional codes and modifiers. The most common coding error is the overuse of modifier -59, which is inappropriate in some situations."
4. Understand the coded anatomy. Coders should understand the anatomy of the spine before coding those procedures, especially as the codes become more specific after the ICD-10 transition. Carefully double check operative notes and documentation before beginning the claim.
"Make sure that the description of the report matches the procedure performed," says Ms. Talton. "Moreover, with ICD-10, it's going to be specific as it relates to anatomy. Coders need to be careful when assigning codes and make sure they understand what procedure the physician performed."
Inconsistencies in the operative reports and procedure described by the physician cause delays, and an inappropriately coded claim will lead to denials.
5. Continue coder education as procedures evolve. Spine surgeries have increasingly transitioned from inpatient procedures to minimally invasive outpatient surgeries. More will be performed in the surgery center setting in the future, as quality and cost-effective data is made available, and coders need to stay educated on new techniques.
"Having the procedure done in an ASC has higher quality than the hospital setting and with reduced cost and overhead," says Ms. Talton. "This saves the insurance company thousands per patient per procedure."
Some are adding 23-hour post surgical facilities to perform more complex procedures. New minimally invasive procedures allow patients to recover more quickly, and the surgery center is able to offer a more favorable nurse-to-patient ratio than the hospital for higher patient satisfaction.
"As technology advances and more physicians and surgeons are educated on technology, I see that performing spine cases will become more of a standard case in ASCs in the future than it is now," says Ms. Talton. "It's up and coming now, and I see it taking off rapidly in the future."
More Articles on Surgery Centers:
5 Steps to Pull Struggling Surgery Centers Out of Debt
Common Coding Mistakes in Ambulatory Surgery Centers: Orthopedic & Pain Management
ASC Reimbursement Trends: On the Up and Up
5 Coding Tips for Spine Surgery at ASCs FeaturedWritten by Laura Dyrda | Wednesday, 23 January 2013 15:18
Here are five tips for billing and coding for spine procedures at surgery centers from National Medical Billing Service's Senior Vice President, Coding Angela Talton.
© Copyright ASC COMMUNICATIONS 2015. Interested in LINKING to or REPRINTING this content? View our policies here.
Top 40 Articles from the Past 6 Months
- 15 things to know about Zimmer Biomet
- Neurosurgeon named in counterfeit spinal implant lawsuit — 5 things to know
- 55 statistics and issues for neurosurgeons and orthopedic spine surgeons — compensation, global device market and more
- 6 spine physicians ranked #1 on Google
- Dr. Aria Sabit pleads guilty to unnecessary spine surgery, faces 11+ years in prison — 5 things to know
- Medtronic pays 8 physicians $1M+: 5 key notes
- Is the Zimmer-Biomet closed merger finally around the corner? 5 things to know
- Another spine surgeon named in "fake implants" lawsuit — This time in Maryland: 5 key notes
- Is Smith & Nephew's cost-conscious strategy working? 5 key notes
- UPMC's Dr. Tanya Hagen dies at age 45
- Medtronic facing product liability lawsuit over Infuse once more: 9 things to know
- Hospitals face 4 lawsuits in connection with unnecessary spine surgeries case — 6 things to know
- Grand jury indicts troubled Texas spine surgeon — 5 key notes
- Patient sues troubled orthopedic surgeon for malpractice — 7 things to know
- 23 statistics for orthopedic surgeons — compensation, net worth & more
- Brigham and Women's Hospital names Dr. James Kang orthopedics chairman: 6 key facts
- 10 trends in the spinal fusion market
- The future of orthopedics: ACOs, bundled payments, gain-sharing & the advantage in change
- Cleveland Clinic standardizes to 2 implant vendors, at least one orthopedic surgeon out
- 22 things to know about Stryker
- 15 things to know about Smith & Nephew
- Spine surgery in a value-based world: Dr. Jed Vanichkachorn on spine bundled payments
- The endless possibilities in spine biologics, artificial disc & outpatient procedures
- Orthopedic surgeon Dr. Michael Reilly's whistleblower lawsuit results in $69M+ penalty for Broward Health — 7 things to know
- Surface technology for spine devices: Key trends & concepts
- Hospital employment vs. independent practice: 5 spine surgeons weigh in
- 5 things to know about physician assistant pay
- Becker's Spine Review Channels
- Current annual & hourly salary rates for orthopedic surgeons: 8 statistics
- 7 trends in the $850M bone graft substitute market
- Surgeon Scorecard — Good or bad for spine? 5 things to know
- 3rd spinal cord injury patient with InVivo's Neuro-Spinal Scaffold improving: 5 key updates
- Did this orthopedic surgeon let his PA perform surgery? Dr. Munir Uwaydah faces conspiracy, $150M fraud & aggravated mayhem charges: 6 key notes
- Former OtisMed CEO gets 2 years in prison in knee device scandal — 5 key notes
- Dr. Sang-Ho Lee awarded Parviz Kambin award for endoscopic spine surgery at NASS meeting: 5 highlights
- 15 things to know about physician shortages
- Renowned orthopedic surgeon Dr. Robert Small dies in bicycle crash — 4 things to know
- NYU Langone welcomes Dr. R. Shay Bess as head of adult spinal deformity: 7 key notes
- Spinal fusion after 10 years: 5 key notes on adjacent segment disease
- Zimmer-Biomet $14B merger finally complete — 6 things to know