10 Articles to Improve Orthopedic and Spine Practice Coding

Laura Dyrda -   Print  |
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Here are 10 articles that can increase reimbursement at orthopedic and spine practices through improving practice coding.

1. 3 Clarifications for Orthopedic Injection Coding. Coding for multiple injections, medication, fluoroscopy and orthography present challenges for coders working on orthopedic claims. In most cases, clear physician documentation can avoid confusion with coding claims. "In the case where a claim is denied or reviewed on audit, the more specific the documentation made by the physician, the better the practice or physician is going to look in appealing the denial," says Bill Gilbert, vice president of marketing at AdvantEdge Healthcare Solutions (AHS). Physicians should dictate whether the injection took place on the right or left side of the body, or whether it was bilateral.

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2. Coder's Guide to Epidurogram (CPT 72275).
Physicians could be potentially losing out on revenue by not documenting what they're actually already seeing, thinking and doing. Many of the requirements needed to code and bill for the epidurogram (CPT 72275) are found in the providing physician's decision-making processes, but are not documented and so only the fluoroscopy (77003) can be reported.

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3. 5 Tips for Increased Accuracy in Orthopedic Practice Coding. Accurate coding is a key element to receiving maximum physician reimbursement and practice revenues. At many practices, unspecific physician reports or inaccurate physician coding can lead to inefficient billing and compensation practices. Wendy Owens-Frierson, CHM, CHI, CPC, CPC-I billing products manager with Avisena, says that lack of documentation from the physician's report leads to six percent of the performed procedures remaining uncoded in the claim.

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4. Watch for These Coding Challenges for In-Office Procedures.
In-office procedures present the most challenges for orthopedic practice coding, says Mu Medical Management Billing Supervisor Ms. Courtney Henderson, CPC, CPC-P. The most common complications are the result of physicians confusing multiple injection codes as well as attaching inappropriate diagnoses to a procedure report. "A lot of doctors don't choose the right diagnoses or all the diagnoses," says Ms. Henderson. Physicians often cite "pain" as the reason for performing a procedure; however, the payor requires a more specific diagnosis, such as joint degeneration, in order to reimburse for the procedure.

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5. 2010 Medicare Payments for 6 Facet Joint Injection CPT Codes. Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level (CPT 64490) — $288.44.

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6. The "BELIEVE IT OR NOT" With Pain Management Coding.
Epidural injections are only reported one time per date of service for a given region, it would not be appropriate to append modifier -50 for a bilateral procedure nor modifier -59 for multiple levels. An epidural injection at T12-L1 is reported with the cervical epidural injection code, but a facet joint injection at T12-L1 is reported with a lumbar facet injection code.

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7. Improving Reimbursement for Spine Surgeons: 6 Tips for Communicating With Coders. Incorrect coding can lead to several difficulties within a practice, including denied claims, practice audits and decreased revenues. Wendy Owens-Frierson, CHM, CHI, CPC CPC-I, a billing product manager with Avisena, says many coding mistakes can be avoided by employing clear communication techniques between the physicians and coders. Ms. Owens-Frierson offers six tips to spine surgeons for improving communication with their coders.

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8. 3 Tips for Coding Orthopedic Procedures in Surgery Centers. During left knee arthroscopy surgery, the surgeon performs both a medial and lateral meniscectomy along with an extensive synovectomy, including the patellofemoral compartment. The coding would be reported as '29880-LT' for the meniscectomies and '29875-59, LT' for the synovectomy performed in the patellofemoral compartment.

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9. 9 Reimbursement and Business Concepts for Orthopedics in ASCs.
The transition to the new CMS ASC payment system, which pays centers at a percentage of HOPD rates, has increased the reimbursement rates of most orthopedic procedures, says Jay Rom, president of Blue Chip Surgical Center Partners. The system, which went into effect Jan. 1, 2008, and was designed to be phased in over a four-year period, continues to benefit orthopedic service lines as the percent of the payment formula determined by the new system is phased into the overall ASC reimbursement rate.

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10. 10 Billing and Collections Best Practices for Orthopedic and Spine Practices From Expert Sarah Wiskerchen. Sarah Wiskerchen, MBA, CPC, is a consultant with Karen Zupko and Associates in Chicago. She has worked with more than 230 clients, representing more than 1,300 physicians in 24 specialties, but she focuses on orthopedics, otolaryngology and neurosurgery. She offers the following 10 best practices to improve billing and collections for orthopedic and spine practices.

Read more of "10 Billing and Collections Best Practices for Orthopedic and Spine Practices From Expert Sarah Wikerchen."

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