Pay attention to graft retrieval, resurfacing, and femoral block and check on carrier specifications. In the last issue of Orthopedic Coding Alert, we looked at how to report additional procedures bundled in hip replacement code(s) that could complicate your code selection. This month, we’ll continue reviewing hip replacement coding challenges by giving you advice on reporting grafts, femoral blocks, and resurfacing. Next month: Look for instruction on coding infection and dislocation interventions with hip replacements [...]
Coding Tips: Don’t Let Hand Drainage Procedures Drain Your Reimbursement (January 2012)
Coding key: Identify which structures are being drained.When your surgeon performs a drainage procedure on patient’s hand, he may target different structures, as there are several points of collection of pus. You may need to report procedures like drainage of a finger abscess, tendon sheath, or palmar bursa. Read on for tips on identifying where in the hand your surgeon did the drainage and how you report it.Look For Diagnosis of Swollen Finger TipYour surgeon [...]
If your practice provides neurostimulion services, note these changes.CCI 18.0, effective Jan.1, brings important changes that could affect your coding for some selected orthopedic services. Our experts advise you on what’s critical in the latest round. Look for Neurostimultors and Epiphyseal Bar Excision AdjustmentsAs of Jan. 1, 2012, you can report neurostimulator electrode array placement, pulse generator implantation, and revision or removal of these along with epiphyseal bar excision code 20150 (Excision of epiphyseal bar, [...]
In Orthopedic Coding Alert, Vol. 15, No. 1, the answer to the reader question “Look At What Was Dissected In Shoulder Arthroscopy” should have also indicated that you report 76000 (Fluoroscopy [separate procedure], up to 1 hour physician time, other than 71023 or 71034 [eg, cardiac fluoroscopy]) if your surgeon did the fluoroscopy. In Orthopedic Coding Alert, Vol. 15, No. 1, the answer to the reader question “Do Not Report Saucerization with Meniscal Repair” should [...]
You Be the Coder: Look For the Bundle in Chondroplasty and Debridement (January 2012)
Question: How do we report the following procedure in shoulder surgery?”Arthroscopy anterior and posterior capsule labrum reconstruction with removal large loose body, debridement of labrum, glenohumeral chondroplasty.”New York SubscriberAnswer: You code 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy) for the Bankhart/labrum reconstruction and 29819 (Arthroscopy, shoulder, surgical; with removal of loose body or foreign body) for the removal of loose body only IF the loose body is 5 mm or greater. The chondroplasty and debridement are bundled [...]
Reader Question: Review Contracts before Directly Billing the Patient (January 2012)
Question: Can you please help us understand if it is better to bill the patient for DME instead of sending the claim to the insurance? The ortho office feels they can get more from the patient than the insurance will pay. The patient signs a waiver. Do the payer contracts not stipulate all covered procedures must be submitted to the payer? Please advise. Ohio SubscriberAnswer: You are correct to be concerned about contract language. Before [...]
Reader Question: Code for Conversion from Partial to Total Knee (January 2012)
Question: How do you code for removal of Vanguard prosthesis, to placing the femoral and entire tibial components?Florida SubscriberAnswer: There are different choices for procedures like these. According to the AMA, you can report 27487 (Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component). You can also report code 27447 (Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing [total knee arthroplasty]) - 22 (Increased [...]
Additional procedures that you report determine your reimbursement.A simple hip replacement may look easy to report, but there could be hidden factors such as additional procedures bundled in the hip replacement code(s) that could complicate your code selection. Read on to know what to report and what to not report when you’re coding hip replacements. (Watch for Part 2 in the next Orthopedic Coding Alert where we’ll cover other hip replacement coding challenges, including grafts, [...]
ICD-10 Update: Look for Underlying Etiology to Determine Chronic Gout Code in ICD-10 (December 2011)
One ICD-9 code expands to five ICD-10 codes.When reporting gout as a cause of arthritis in 2013, you will need to look at the underlying cause of the gout, irrespective of the site involved, to pick up the right ICD-10 code. Here is how you will narrow down your choice from five available codes for chronic gout with tophi when the Oct. 1, 2013 deadline hits.Gout, essentially a disorder of uric acid metabolism, can progress [...]
Got a Hip Replacement? Know What Services Are Bundled (December 2011)
You will often need to report a number of different additional procedures with hip replacement. The list is exhaustive. We list out the procedures here that are common in any practice and this may be a quick easy reference for you.Arthrotomy, with drainage, biopsy, or synovectomy, and removal of foreign body is inclusive in the code(s) for hip replacement. So are open tenotomy, osteotomy, manipulation of hip joint, acetabuloplasty, and craterization and saucerization. “Synovectomy, capsulectomy, [...]
