1. Be specific when coding for fluoroscopy and arthrography. Physicians use fluoroscopy for needle localization and guidance to make sure they are injecting in the correct location. Arthrography can also be used for guidance but it has diagnostic purposes as well. Some payors, such as Medicare, will not reimburse for fluoroscopy or arthrography in some joints. Corey Stavinski, CPC, of AdvantEdge Healthcare Solutions, and Peggy Bothwell, LPN, CPC, coding manager at AHS, say that clear physician documentation is necessary to code for the instances when physicians are able to receive reimbursement. In the operation report, physicians must include a description of the patient’s anatomy, structures, where the needle was placed, the spreading of the dye, what type of dye was used and the findings within the joint area. The findings can be included in the operation report or in a separate report; it is helpful to the coder if the findings are at least in a separate paragraph in the operation report.
Additionally, coders need to know whether the equipment is owned and maintained at the facility. If the physician is using equipment owned and maintained by a hospital, he or she cannot bill for the use of that equipment.
2. Distinguish open, closed or percutaneous skeletal fixation procedure. Opened and closed procedures are billed differently and incur separate reimbursement values, says Wendy Owens-Frierson, CHM, CHI, CPC CPC-I, a billing product manager with Avisena. In order to code for an open fracture procedure, the physician makes a surgical incision as part of the treatment (exposed to the external environment). If an incision is not made, the fracture is treated as a closed procedure (exposed to the external environment and directly visualized). The Percutaneous skeletal fixation describes a fracture that is neither open nor closes, this procedure requires fixation (e.g. pins) is placed across the fracture site, usually under x-ray imaging. Even if the patient arrives with an open wound associate with a fracture, the open procedure does not always indicate an “open fracture.” If the wound is superficial and does not expose the fracture site, then the fracture is coded as closed.
3. Know the rules to get paid in full. While some practices bill too many services separately, others lean too much the other way and bundle more than they need to, says Sarah Wiskerchen, MBA, CPC, is a consultant with Karen Zupko and Associates in Chicago. This means they won’t get the full amount they deserve. The AAOS guidelines help physicians and staff members understand what is included and excluded in each surgical procedure code.
This concept also applies to orthopedic and spine office services as well. For example, when surgeons encounter a new problem within the 90-day global period, they should use modifier -24 and an appropriate diagnosis to support the new problem. In another example, some payors inappropriately deny cast application charges that occur in the global period of fracture care, which should be paid separately.
4. Physicians must dictate all necessary information. When dictating, physicians should describe the surgical procedure in detail, allowing the coder to clearly visualize the entirety of the surgical encounter. This should include the type of approach used (endoscopic, percutaneous, open procedure, etc.), whether the procedure was anterior or posterior, the laterality and if the surgeon operated on more than one level. Physicians should also describe any implants/graft used, and include details such as the type of implant and the number of units used (i.e., screws). Finally, the physician’s report should also establish medical necessity for the procedure, which needs to be defined through diagnosis codes.
5. If claims are denied, deal with them immediately. Curt Mayse, a principal with LarsonAllen, says that practices should focus on getting their collections out of the door immediately following a patient visit. “These should be sent within minutes or hours, not days, of a visit,” he says. “This way, the practice will get their reimbursements or denials back quicker from insurance companies.” When practices receive a denial, Mr. Mayse says that they should not sit on this information. “The business office should pass the reasons for the denial on to the front-end to communicate to them why the claim was denied.” By improving the communication between these two parts of the practice, offices can cut down on repeat mistakes and improve their overall collections and billing.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
