Even when physicians code from a procedure list, modifiers or add-ons can be missed.
“Basically, in the operative report the physician wants to begin by stating he’s beginning surgery. He needs to be very specific on the technique, for example decompression versus normal compression, and whether he’s using any devices, such as implants,” says Ms. Owens-Frierson. She discusses the key elements for physicians as they report patient visits, injections and procedures commonly associated with orthopedics and sports medicine.
1. Learn to speak “code.” For most accurate billing results, Ms. Owens-Frierson recommends physicians use the “coding” language in their reports instead of describing the procedure as a narrative. “When physicians are not using the coding language, there’s a loss in revenues,” she says. “The documentation is key in selecting and capturing all the appropriate and billable codes.” By becoming familiar with common codes for each step of the procedure, physicians can better relay the procedure performed to the coders which results in more accurate billing practices and increased revenue.
2. Report trigger point injections. Ms. Owens-Frierson says when a patient arrives for a consultation visit already in pain the physician will often administer a trigger point injection for pain relief in addition to the visit. In these cases, some physicians only report the consultation and as a result are not reimbursed for the trigger point injection. “If the injection is documented and the modifier 25 is not appended to E and M code the physician will not receive credit for it.”
3. Report decision for surgery. If the physician decides their patient needs surgery during an initial visit or consultation, the recommendation for surgery is identified by appending the 57 modifier to the E and M visit. For Medicare patients, the decision must be made preoperatively in order to use the -57 modifier. Coding with this modifier will ensure additional compensation for the initial visit or consultation.
4. Beware of medical device company coding tips. Some medical device companies will offer advice to the healthcare provider on coding procedures using the company’s device. Ms. Owens-Frierson says such advice can be inaccurate or confuse the physician when he or she is reporting on the actual procedure. If inaccurate codes are used, this confusion could lead to an audit. She recommends the coders and providers do their own research on Medicare guidelines and FDA approval for the products.
5. Use Category III Codes when applicable. For many new procedures and technologies, temporary, or Category III CPT Codes, are available when billing for a procedure. Ms. Owens-Frierson says using the Category III CPT Codes increases reimbursement. For example, the when performing the total disc arthroplasty, the physician can use the 0164T code signifying the removal of a disc in the back.
If the physician needs to make additional incisions or interspace for the artificial discs in the lumbar area after the surgery has begun, he or she should specify as much in the report. Coders can use Category III CPT Codes to bill for the extra work.
Learn more about Avisena.
Read other coverage on accurate coding:
– Watch for These Coding Challenges for In-Office Procedures
– 5 Steps to Finding the Right ASC Reimbursement Cycle Employees
