Stephanie Ellis, RN, CPC, is the president and owner of Brentwood, Tenn.-based Ellis Medical Consulting, and Lolita M. Jones, RHIA, CSS, is an independent coding and billing consultant.
Here Ms. Jones and Ms. Ellis elaborate on seven trouble areas for coding orthopedic and pain management procedures.
1. Fracture debridement. Coders frequently do not recognize debridement of an open fracture, since it may be only a couple of words in the operative report. They should pay close attention to fracture care in case debridement is mentioned. If it's noted by the surgeon at all, it must be coded in addition to the fracture treatment, Ms. Jones says. The correct code to use is 11010, 11011 or 11012.
2. Tendon grafts with ACL reconstruction. The 20924 code for the harvest of a patellar or hamstring tendon graft is billable only when the graft is obtained from the opposite knee or from either ankle, Ms. Ellis says.
The current procedural guidelines state the graft must be "from a distance" when billed with the 29888 ACL repair code, which means the tendon graft cannot come from a separate incision in the same knee. Coders should be aware of where the graft came from.
"[This does] not constitute a far enough distance to bill for it separately, according to CPT guidelines, even though it is not unbundled in the CCI material and it is performed through a separate incision," she says.
3. External fixation. Most fracture treatment codes have been revised so external fixation has to be coded separately, Ms. Jones says. Coders often follow rules from years past, when external fixation was included and inadvertently lose revenue.
4. Sacroiliac joint injections. Sacroiliac joint injections can be confusing because of there are several variations used depending on the procedure and the payor. Coders should use 27096 — which documents the injection procedure for a sacroiliac joint, arthrography and/or anesthetic or steroid — when billing commercial payors or billing the physician's surgical service, Ms. Ellis says.
When billing Medicare for the same procedure, coders should use the CPT G0260, which documents the injection procedure for a sacroiliac joint. Imaging is included in both of these codes and should not be billed separately.
However, if the joint injection is performed without fluoroscopic guidance or arthrography, coders should use 20610, injection into a major joint. The 20610 code does not include imaging and would be used by both the physician and the ASC facility for billing to all payors, she says.
5. Hardware or implant removals. Deep pin removals done in an ASC require the code 20680. The physician will have to make an incision to visualize the implant, but the code is only to be billed once per fracture or previously operative site, regardless of the amount of hardware removed or the number of incisions made, Ms. Ellis says. The code can only be billed twice if the surgeon removes an implant or hardware from a completely different surgical or anatomical area.
6. Nerve branch destruction. For pain management treatments, rather than reporting the destruction of each nerve branch separately, coders should be reporting based on each intervertebral joint destroyed, Ms. Jones says. Each joint is supplied by two nerve branches, so coding separately would double the cost of the bill. Physicians may balk if they used a separate needle for each nerve branch, but that does not change the coding.
More Articles on Coding, Billing and Collections:
AMA to Include CPT Codes in the Genetic Testing Registry
MedCare MSO Launches Medical Coding, Billing Blog
CMS Clarifies Medicaid, Health Exchange Provisions From Affordable Care Act
Common Coding Mistakes for Orthopedic & Pain Management in ASCs FeaturedWritten by Heather Linder | Thursday, 24 January 2013 16:44
Procedural coding errors can lead to lost revenue or unintentional upcoding at ambulatory surgery centers.
© Copyright ASC COMMUNICATIONS 2016. Interested in LINKING to or REPRINTING this content? View our policies here.
Most Read - Billing & Coding
Top 40 Articles from the Past 6 Months
- 22 spine surgeon leadership awards | 2016
- Has Xenco Medical Ushered in the Future of Spine Surgery?
- Orthopedic surgeons generate $2.7M for affiliated hospitals; 5.5 times what they make — 5 survey findings
- Where global spine market leaders are headed: 7 key notes on Medtronic, DePuy Synthes, Stryker & more
- Novel technologies make a splash in outpatient spine setting — Dr. Nick Shamie weighs in
- 21 smart spine surgeons with gifted business minds
- PODs under attack again: 5 key notes from the Senate Finance Committee's report
- Top 12 most-liked spine surgeons on the internet
- Siemens, Ziehm, GE, Hologic, OrthoScan & Medtronic: 26 O-arm & C-arm systems
- Consumer Reports: 34 top-rated US hospitals for hip replacements
- Dr. George Rappard performs 1st US MIS procedure with Sony heads-up display: 5 observations
- Orthopedic surgeons leave Salina Regional over on-call payment dispute: 5 things to know
- Andrews Institute adds regenerative medicine, stem cell center: 5 things to know
- Zimmer Biomet to acquire LDR in $1B transaction — 9 things to know
- Annual & hourly orthopedic surgeon salary — 10 latest statistics
- ISSCR updates stem cell research guidelines; warns against stem cell medical tourism — 5 insights
- The low hanging fruit of HIPAA compliance: 8 best practices
- Trusting a robot — Dr. Juan Torres-Reveron on performing 1st US ROSA Spine surgery
- 44 MIS spine devices to know | 2016
- How Responsive Orthopedics defied the industry norm to make knee, hip devices more affordable — 6 key insights
- Paradigm Spine pays $585k in False Claims Act settlement; denies allegations: 5 things to know
- 87% of solo practitioners to face MIPS penalty in 2019 — 6 statistics on how Medicare's new payment model may impact solo physicians & small practices
- 20 new MIS spine devices in 2016
- Surgeon entrepreneur: Dr. Kern Singh's quest to make lateral spine surgery more accessible
- 5 key notes on the Zimmer Biomet-LDR acquisition & its impact on Texas
- 12 statistics on social media's presence in the healthcare space
- MIS spine's promising future — Key insights from SMISS President Dr. Greg Anderson
- UPMC to pay $2.5M+ to settle neurosurgery-related False Claims Act violation allegations: 7 things to know
- 5 key points on Midwest Orthopaedics at Rush's bundled payments making healthcare affordable & transparent
- US News & World Report: Top 10 hospitals for orthopedics
- Oregon spine surgeon implicated in $22M lawsuit for paralyzing patient with dropped instrument: 5 things to know
- Bundled payments to account for 30%-45% of spine reimbursement in 3 years: 4 insights
- 'Spare the scalpel' — Dr. Brian Cole sheds light on the future of orthopedic medicine in TEDx Talk
- 7 things to know about Mazor Robotics & Medtronic's plans to roll out Mazor X
- 4 North Carolina orthopedic practices merge to create EmergeOrtho: 5 key notes
- The state of minimally invasive spine surgery: Dr. Frank Phillips on devices, payment & outpatient ASCs
- Orthopedic surgeon Dr. Michael Russin dies following plane crash: 5 key notes
- Raleigh Orthopaedic Clinic to pay $750k in potential HIPAA violation: 5 things to know
- How did 5 orthopedic device giants fare in the most recent fiscal period? 45 notes on Stryker, Medtronic & more
- Zimmer Biomet jumps into robotics with MedTech acquisition: 5 things to know