While the standardization of CPT codes has been a net positive for orthopedics in terms of billing and reimbursement, there are some nuances that standard codes don’t address on a case-by-case basis.
Standardization has led to some surgeons placing quantity over quality, making it difficult for patients with complex surgical needs to get timely care.
Richard Yoon, MD, Director, Orthopedic Research Division of Orthopedic Trauma and Adult Reconstruction Surgery of Jersey City (N.J.) Medical Center, recently connected with Becker’s to share how code standardization has both helped and hindered orthopedics.
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Editor’s note: This response has been lightly edited for clarity and length.
Question: What is one area where standardization has helped orthopedics, and one where it has hurt?
Dr. Richard Yoon: I think the standardization of CPT codes has greatly streamlined billing coding and reimbursement; however, at the same time, it has harmed the same process by not allowing for grading of complexity.
A primary total hip or knee replacement can come in a wide range of degrees of severity, and a single code should not reflect those that are most complex. The standardization has indirectly placed quantity over quality and does not reward those surgeons to take on complex clinical cases. As a result, those patients who are likely most in need often get delays in care and needed surgery, finding the surgeon who has the willingness and experience to take on those challenging cases.
