5 strategies to ensure accurate coding and billing in spine and pain management

Practice Management

Accurately billing for spine surgery and pain management can pose a challenge for many ASCs, says Lisa Rock, president of National Medical Billing Services.

This content is sponsored by National Medical Billing Services.

During Becker's 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference on June 23, Ms. Rock and Tamara Wagner, National Medical Billing Services' vice president of performance review, discussed the various obstacles to proper coding and billing ASCs face and shared a few strategies to ensure successful reimbursement.

Here are five pieces of advice from Ms. Rock and Ms. Wagner.

1. Ensure your coders are well-versed in spine anatomy. Coders must be able to match the spinal nerves involved in a particular surgery to the proper code and assign an accurate number of levels, said Ms. Wagner. "If your coders don't understand the anatomy, you can miss out on revenue," she said.

2. Make sure physicians take detailed, accurate operative notes. The intent of the procedure and how it is performed should be well documented in the operative note, according to Ms. Wagner. She said inaccurate or incomplete documentation is probably 50 to 60 percent of the challenge for a coder.

Ms. Rock recalled a time when she had to follow up with a surgeon who had not documented the size of a lesion removed from a patient in the operative note. "He said it was the size of an olive, so I wrote back: Pimento-stuffed? Medium? Black?" she said. "I joke because I know how busy surgeons are, but if you're trying to get your bills, you need to have accurate documentation."

3. Stay on top of all medical policy changes by carrier. The ICD-10 codes for Medicare and commercial payer policies vary greatly. These policies are also being updated more frequently and asking for more detailed information on a patient's total care process to determine medical necessity. Coders must be aware of the differences and updates to each policy's requirements, said Ms. Wagner. Coders must also keep track of which codes have been deleted or replaced, as payers will reject the claim if you use an outdated code, added Ms. Rock.

 4. Hold patients responsible for their portion of the bill. The Healthcare Financial Management Association projects patients will be responsible for 40 percent of a healthcare provider's bill by 2020, according to Ms. Rock. She said surgery centers have often turned a blind eye to patient responsibility in the past and recommends they implement a root internal collections policy.

5. Don't be afraid to use technology. Ms. Rock said switching to high-tech billing practices will be key to ASCs' success. "You cannot keep staffing for everything carriers are requiring today," she said. "Using automated registration tools, patient portals to eliminate calls [and other automated services] will help reduce staff expenses and increase cash."

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