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Orthopedic Coding Alert

Say Goodbye to Unlisted-Procedure Codes for Kyphoplasty in 2006
CPT introduces 5 new spine codesAfter years of waiting, orthopedic coders can finally star... Read more
CPT Brings ESWT Coding From Temp to Perm
Look for new codes for plantar fascia shock wave therapy in 2006If your foot surgeon relie... Read more
3 Steps Lead the Way to Finger Repair Reimbursement
Consider the closure method to choose the correct amputation codeIf your orthopedic surgeo... Read more
CPT 2006 Redux:
Were You Hoping for More Codes in the New Year? Write a Letter
The process may be complex, but your associations can help you make it happenEvery year, y... Read more
Don't Unravel When You Report Unlisted-Procedure Codes
Critical ways you can combat carrier challengesCPT coding is not an exact science, and the... Read more
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Get to Know Orthopedic Surgery's Most Popular Unlisted Procedures
            If you can never quite determine which u... Read more
When ED Refers Patient, Don't Bill Consult
Question: When an emergency department physician tells a patient to follow up with our pra... Read more
Separate Compartments May Mean Extra Pay
Question: Our surgeon performed an arthroscopic Bankart procedure (29806) and a rotator cu... Read more
Make Multiple-Injection Pay Easier
Question: Our surgeon performed a lumbar epidural steroid injection (LESI) and an SI joint... Read more
Modifier 57 Use Depends on Time Span
Question: My physician is adding modifier 57 to all E/M visits in which he makes the decis... Read more
Look to 27005 for Illiopsoas Tendon Release
Question: Which code should we report for an iliopsoas tendon release?Kansas Subscriber A... Read more
Be Selective When It Comes to Debridement
Question: Can our in-office nursing staff report 97597-97598 for selective debridement? I-... Read more
Mandated Service? Try Modifier 32
Question: A local orthopedic surgeon (not in our practice) recommended an arthroscopic SLA... Read more
You Be the Coder:
How Should We Choose Instrumentation Type?
Question: How can I distinguish segmental from nonsegmental instrumentation?Connecticut Su... Read more
Operative report Examination:
Reporting Unlisted for Shoulder Resurfacing Hemiarthroplasties? Read This First
Coding for this new surgery shouldn't differ from standard shoulder hemiarthroplastiesMost... Read more
NCCI Update:
If It Ain't Broke, Don't Code Fixation
National Correct Coding Initiative version 11.3 targets 20690If your orthopedic surgeon re... Read more
News You Can Use:
Practices Could Lose $1,000 Per Week Under New Rule
CMS wants to stop paying separately for casting suppliesIf your office provides a lot of c... Read more
Eliminate the 'Work' From Coding Workers' Comp Claims
Heads-up:  Not every state uses current-year CPT codesYou won't find any national sta... Read more
Choose 29806 for Bankart Repairs
In the July Orthopedic Coding Alert, we advised coders to report 29807 (Arthroscopy, shoul... Read more
Orthopedic Coders' Salary Survey:
Want to Earn More Money? Stay on the Job
Our survey proves that longevity in the orthopedic field will bring in more money for code... Read more
Guest Column:
Beth Janeway, CPC, CCS-P, CCP: Set Your Coding Career on Fire
Tip:  Ask your surgeon whether you can shadow him for a dayIf you-re as encouraged as... Read more
It's True:
Experienced Coders Really Do Earn More
Stay in the field and reap the benefits, our results showDetermine whether your salary is ... Read more
Alphabet Soup:
What Do All The Certifications Mean?
Before you crack the textbooks and hop on the certification train, you should understand t... Read more
Confirm Whether ED Visit Qualifies as Consult
Question: A hospital ED physician asked my on-call orthopedic surgeon to admit a patient. ... Read more
Category III Codes May Contain Global Days
Question: What are the surgical global days for the IDET procedure (0062T-0063T)?Ohio Subs... Read more
Consider 26615 for Osteoclasis
Question: Our orthopedic surgeon performed open osteoclasis to treat a right proximal fift... Read more
Check Injection Type for Fluoro Rules
Question: Our orthopedic surgeon sometimes uses fluoroscopic guidance for wrist injections... Read more
Expect Less Payment for G0289
Question: If our surgeon performs separate compartment chondroplasty (G0289) with meniscec... Read more
Limit 63276 to Posterior Side
Question: Can we report 63276 for each laminectomy level that the surgeon addresses? Also,... Read more
You Be the Coder:
Where Is the Suprapatellar Pouch?
Question: Our surgeon performed a medial meniscectomy, followed by a plica resection in ... Read more
3 Strategies Help You Code Bone Biopsy Procedures Correctly
You may be able to report both lesion biopsy and excision If your insurer's policy... Read more
2 Sites, 2 Line Items:
Know the Lower-Extremity MRI Rules
Make the most of modifiers for leg-joint imaging reports Even if you-re familiar with cod... Read more
Say Goodbye to Confirmatory Consult Codes in 2006
CPT will revamp consult coding next year You can forget the rules you learned about disti... Read more
ICD-9 Reminder:
Start Using Your New Diagnosis Codes on Oct. 1
Orthopedic coders cheered earlier this year when  ICD-9 2006 introduced nine new pros... Read more
Guest Column:
David V. Janeway, MD--Tennis and Golfers' Elbow: They're Not Just the Participant's Problem Anymore
The surgeon's notes will give you a hint about the right codes to report If your head spi... Read more
Benchmarking Update:
Compare Your Elbow Surgery Code Utilization to Others'
You-ve charted your E/M code usage against averages--now take the next step In the Ju... Read more
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Use This Elbow Surgery Benchmarking Data as Your Guide When Comparing Fasciotomy Usage
Medicare data reveals the most frequently reported elbow surgery codes Tally up your prac... Read more
Reader Questions:
Pain Pumps May Not Be Billable
Question: Our surgeon performs multi-level posterior and anterior spinal fusion surgeries ... Read more
Reader Questions:
Report Digital Blocks, but Not With Surgery
Question: When is it appropriate to report a digital block? Is it always bundled?New York ... Read more
Reader Questions:
Confirm Spinal Block Location for Fluoro
Question: Can I report fluoroscopy in conjunction with pain management blocks? If so, whic... Read more
Reader Questions:
Report Limited EMG for Fewer Than 5 Muscles
Question: What are the guidelines for reporting electromyography codes 95860-95864? How do... Read more
Reader Questions:
Look to Modifier 58 for Double Fracture Care
Question: Last week, our surgeon reduced a patient's distal radius fracture and we charged... Read more
Reader Questions:
Avoid Trigger Point Codes for Trochanteric Bursa
Question: How should I code injection of trochanteric bursa and sacral crest? My orthopedi... Read more
You Be the Coder:
Do ACE Bandages Qualify as Strapping?
Question: A patient sprained his thumb MP joint while playing youth football. The orthoped... Read more
Coding Case Study:
Use the Right Modifier to Protect Your 3-Step Foot Surgery Pay
Subtle differences between 58 and 78 will unlock payment Orthopedic surgeries often requi... Read more
Say Goodbye to Unlisted Codes For Artificial Disk Procedures
New 0090T-0098T series allows coders to get specific You now have nine new codes to choos... Read more
Use This Information to Justify Reporting Category III Codes
When a category III code exists to describe a service or procedure, you must use that cate... Read more
Coding Quiz:
Boost Your Bottom Line- Report E/M With Service When Justified
Test your knowledge of E/M visits with procedures with this coding quiz Correctly coding ... Read more
Back-to-School Special:
Avoid Problem-Focused E/M Codes for Sports Physicals
Assessing an athlete's fitness level? Ask for payment up-front Autumn means that many spo... Read more
Guest Columnist:
Mary Brown, CPC, CMA- Consistency Reigns When Reporting Fracture Care
Casting and E/M or fracture care global codes? A coder shows you the way School is back i... Read more
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Keep Your Top-Billed Supply Codes at Your Fingertips
                We've researched the casti... Read more
Reader Questions:
Differentiate Between Arthritis Diagnoses
Question: Which diagnosis code should we report for acromioclavicular joint arthritis? We ... Read more
Reader Questions:
Stick With Modifier 79 for Unrelated Procedures
Question: Our orthopedic surgeon performed an open reduction with internal fixation (ORIF)... Read more
Reader Questions:
Don't Charge Medicare for These Bone Grafts
Question: Do insurers bundle bone graft procedures 20930 and 20936 into arthrodesis proced... Read more
Reader Questions:
Avoid Rotator-Cuff Codes for Deltoid Repair
Question: Our surgeon repaired the deltoid muscle as an open procedure. We're considering ... Read more
Reader Questions:
Let Unlisted Lead the Way for Subtalar Implant
Question: What are the correct codes to report a subtalar arthroereisis with MBA implant d... Read more
Reader Questions:
Nerve Exploration Is Probably Included in Elbow ORIF
Question: Our surgeon performed an open reduction with internal fixation (ORIF) of the lef... Read more
Reader Questions:
Consider What Surgeon Excised to Choose Code
Question: Our surgeon performed a cyst excision to the distal interphalangeal (DIP) joint ... Read more
You Be the Coder:
How Should We Report Assistant at Surgery?
Question: Our surgeon performed an arthroscopic subacromial decompression (29826) and a Mu... Read more
Dispel These 3 Common Spine Coding Myths At the Root of Reduced Reimbursement
Surprise: You can report instrumentation removal during repeat fusions A surgeon performs... Read more
Let Tendon Transfer Site Lead You to the Correct CMC Arthroplasty Transplant Code
You must determine where the surgeon got the tendon   You can avoid problems codi... Read more
Look for 29873, 29883 Payment Combination Issues
Our July article "Expect a Pay Cut When You Report 29873 With Other Surgeries" included a ... Read more
NCCI Update:
Expect Denials for Claims Including G0351
New drug admin code follows 90780-90784 example, coding experts say Orthopedic practices ... Read more
Knee Coders' Toolkit:
Revealed - Answers to Top-5 Knee Coding Questions
 Want to know what you can bill with your arthroscopy claims? Look no further We&... Read more
Guest Columnist:
Bill Mallon, MD - Know Your Knee Compartments to Select Arthroscopy Codes
A surgeon's perspective on gleaning codes from op reports If your practice suffers from t... Read more
Appeal Your Chondroplasty Claims With Confidence
 Use this template to show the payer why you deserve reimbursement Although Medicare... Read more
Reader Questions:
Expect Carrier Resistance to 61795
Question: Our surgeon used stereotactic navigation (61795) during laminectomy with fusion,... Read more
Reader Questions:
Selectively Report E/Ms With Supartz Injections
Question: Can we bill an office visit along with a supartz injection for patients on every... Read more
Reader Questions:
Address Front and Back of Shoulder for 29823
Question: Our surgeon performed an extensive glenohumeral debridement and then he left the... Read more
Reader Questions:
Let Surgeon Choose Os Acromiale Code
" Question: Which ICD-9 code should we report for an Os acromiale? The patient pr... Read more
Reader Questions:
Consider 15920 Series for Decubitus Ulcer Care
Question: Our surgeon saw a patient status post hip replacement and he debrided two sites ... Read more
Reader Questions:
Look to Unlisted for Iliac Crest Bone Graft Injection
Question: My surgeon performed an iliac crest bone graft injection for pain (Kenalog, down... Read more
Reader Questions:
Open Fractures May Not Require Open Care
Question: Our orthopedic surgeon documented fracture care for an open scapula fracture, an... Read more
Reader Questions:
All Staff Members Can Perform History Element
Question: My coworker thinks an orthopedic surgeon must take a patient's history. But I th... Read more
You Be the Coder:
Don't Count on PRP Injection Pay
Question: Our surgeon performed open reduction/internal fixation (ORIF) on a right intertr... Read more
New Diagnosis Codes Eliminate Ambiguity When You Report Prosthesis Complications
The 2006 crop of ICD-9 codes will help describe family histories, problems with prosthetic... Read more
Op Report Examination:
Take 3 Steps to Bill Patellofemoral Ligament Reconstruction
Confirm whether graft came from separate incision or fascial exposure You may be famil... Read more
News You Can Use:
Expect a Pay Cut When You Report 29873 With Other Surgeries
CMS adds arthroscopic knee lateral release to endoscopic knee group Thanks to a new Medic... Read more
Meet the Families:
Check Out the Endoscopic Base Codes for Orthopedists
They could affect your reimbursement Learning Medicare's multiple-endoscopy rule is a tim... Read more
How Does Your Code Usage Compare to Other Orthopedic Surgeons'?
Benchmarking can help you determine whether you're on track If you want to find out wheth... Read more
Guest Columnist:
Frank Cohen, CMPA - Determine Practice's Complexity Level to Normalize Stats
Figure out your acuity factor so you can compare apples to apples If HIPAA has become a s... Read more
Orthopedic Coding Alert Welcomes 2 New Blue-Ribbon Panel Members
As part of our launch of the Orthopedic Coding Alert: Extra, which will give our readers f... Read more
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CMS' Orthopedic Data Can Get Your Benchmarking Study off The Ground
Compare your practice's code usage against national averages... Read more
Reader Questions:
Document PT, Even When Unbillable
Question: Our physical therapist spent only six minutes applying an ultrasound to a patien... Read more
Reader Questions:
Apply 27822 to Trimalleolar Fracture Care
Question: Our surgeon performed an open reduction with internal fixation (ORIF) on the med... Read more
Reader Questions:
Toe Surgery Code Covers Several Procedures
Question: Our foot surgeon documented capsulorrhaphy of the second metatarsophalangeal (MT... Read more
Reader Questions:
Describe Labral Tear Repairs With 29807
Question: Our surgeon performed arthroscopic anterior and posterior labral repairs. Should... Read more
Reader Questions:
Bill 20924 When Harvesting From Opposite Knee
Question: Do insurers include graft harvest in the ACL repair code 27407? Our surgeon made... Read more
Reader Questions:
Don't Stop Reading Op Report Halfway Through
Question: Our surgeon performed a complete T7 and partial T6 corpectomy with vertebroplast... Read more
Reader Questions:
List Fracture Care Codes According to RVUs
Question: Which diagnosis code should I list as primary when a patient suffers multiple fr... Read more
You Be the Coder:
Is Sagittal Band an Extensor Tendon?
Reviewed on May 20, 2015 Question: Is a sagittal band in the metacarpal (MCP) area an ... Read more
Include Pain Pump Insertion in Knee, Shoulder Surgeries
You can usually collect for spinal pain pump insertions, but most other pain pumps bundle ... Read more
5 Answers Satisfy Your Top Facet Joint Injection Questions
Hint: You may be reporting too many units of 64470-64476 When billing facet joint inje... Read more
Chondroplasty Coding:
Looking for Regs on the '15-Minute Rule'? Look No Further
If leafing through pages of the Federal Register is not your cup of tea, we can help.In ou... Read more
Reader Questions:
Avoid 29877 for ACL Debridement
Question: Our surgeon performed an arthroscopic partial ACL debridement, partial medial ... Read more
Reader Questions:
'T' Codes Will Replace Unlisted for Disk Placement
Question: Which code should I use to describe placement of artificial disks? I'm leaning t... Read more
Reader Questions:
95904 Describes 'Mixed' Nerve
Question: What is a "mixed" nerve? How should I report nerve conduction studies for a mixe... Read more
Reader Questions:
27506 Includes Nail Insertion
Question: Our surgeon performed an open reduction with internal fixation (ORIF) on a fract... Read more
Reader Questions:
Choose Between Acute, Chronic for RTC Repairs
Question: Our surgeon performed an open rotator cuff repair, subacromial decompression, an... Read more
Reader Questions:
Obesity Differs From Morbid Obesity
Question: We performed several knee replacements on an obese patient, and the surgeon want... Read more
Reader Questions:
Consider 23395, 23465 for McLaughlin Procedure
Question: Our surgeon documented a McLaughlin procedure for a reverse Hill-Sachs lesion. W... Read more
Reader Questions:
Don't Sweat the Sports Lingo ICD-9 Coding
Question: Is there a difference between golfer's elbow and tennis elbow?West Virginia Subs... Read more
Reader Questions:
Try to Avoid Last-Minute Documentation
Question: Last August, we billed 99213 for an office visit. Now, the patient's insurance c... Read more
You Be the Coder:
Which Code Describes an Osteochondral Fx?
Question: Which ICD9 Code should we report for an osteochondral fracture of a tarsal bon... Read more
Solve the Hip Surgery Denial Dilemma With 3 FAQs
Modifiers may make the difference for your difficult hip procedure claims If your orthope... Read more
Billing 29877 With 29868? Not Anymore
New edition of NCCI bars you from billing meniscal transplant with debridement If you... Read more
Modifier Primer:
Link to Original Procedure Helps You Choose -78 or -79
If the first procedure didn't necessitate the second procedure, look to -79 When you have... Read more
Reader Questions:
Apply 1 Code for These 2 Fractures
Question: A pediatric patient presented with radius and ulna shaft fractures of the left a... Read more
Reader Questions:
Use -LT, -RT for Bilateral Knee Replacements
Question: Our surgeon recently performed bilateral total knee replacements at the same tim... Read more
Reader Questions:
Look to 20975 for Invasive Bone Healing Stimulator
Question: Our physician inserted a bone healing stimulator. How should we report this serv... Read more
Reader Questions:
Delta Prosthesis May Warrant -22
Question: One of our surgeons plans to perform a Delta prosthesis procedure soon, and she ... Read more
Reader Questions:
2 Admissions May Mean 2 Initial Consult Codes
Question: Our surgeon performed an inpatient consult for a car-accident patient. He discha... Read more
Reader Questions:
Don't Fear Billing 29880 With 29879
Question: Can we bill 29876, 29879 and 29880 together? Because 29880 includes the meniscec... Read more
Reader Questions:
Know the Reasons for Hemiarthroplasty
Question: I can't tell the difference between codes 27125 and 27236. If a surgeon document... Read more
You Be the Coder:
Which Code Describes a Pectoralis Repair?
Question: Our patient ruptured the right pectoralis major muscle while doing a bench pre... Read more
Case Study:
Simple Guidelines Help Streamline Your Knee Arthroscopy Coding
" Not every plica excision and bursectomy will warrant separate codes If you q... Read more
Q and A:
Get a Handle on Coding for Compartment Syndrome
" Should you bill pressure measurements per compartment, or extremity? Coding... Read more
4 Tips Help You Code Physical Therapy Correctly Every Time
Don't use 97110 as a one-size-fits-all exercise code Do you know which type of pr... Read more
Modifier -50 Works With Facet Joint Injections
Question: Can we append modifier -50 to bilateral facet joint injections (64470-64476)? If... Read more
Number of X-Ray Views May Not Drive Units
Question: How many foot x-ray views must we take to bill 73620 and 73630? And should we us... Read more
Report Diskography per Level
Question: If a physician performs diskography at L2-L3, L3-L4 and L4-L5, how many tim... Read more
Look to 72050 for 4-View Spine X-Ray
Question: If we perform anteroposterior (AP) and lateral views of the cervical spine and l... Read more
Post-Fusion Injections May Require Unlisted
Question: Which codes should I report if the physician documents "hardware injections in t... Read more
Use Modifier -80 Only for 2 Primary Surgeons
Question: If two surgeons work together during a procedure, should I apply modifier -62 or... Read more
Avoid -50 With 'L' Codes
Question: We billed two inserts of L3010 (Foot insert, removable, molded to patient model,... Read more
You Be the Coder:
Does CPT Include a Spondylolisthesis Code?
Question: Which CPT code should we report when the orthopedist performs a reduction of spo... Read more
Want to Ace Hip Procedure Coding? Here's How
Learn how 0054T-0056T can ease your CAD claimsWhen a patient presents for a follow-up visi... Read more
Coding Triple Hip Reduction Often Requires Modifiers
Prosthesis dislocations during global can be payable, if you know how to billIf your patie... Read more
Know the Ropes When You Tackle Pilon Fracture Coding
" Pilon fractures sometimes involve the fibula If you think you can't bil... Read more
Coding Quiz:
4 Scenarios Put Your Same-Day Modifier Use to the Test
Multiple procedures or spinal levels may merit modifiers, but not always When your orthope... Read more
Don't Count on Casting Supply Reimbursement
Question: When can we bill for cast supplies? Can we bill "Q" codes with initial fracture ... Read more
Thermal Shrinkage? Report Unlisted
Question: Our surgeon performed an arthroscopic thermal shrinkage of the ACL. Which code s... Read more
Bundle 99238 Into Surgical Package
Question: Can we report 99238 to reflect the surgeon's work discharging a patient if the p... Read more
Seek Local Payer Guidance for Intraop Fluoro
Question: Which code should we report if our surgeon interprets intraoperative fluoroscopy... Read more
Look to 958.4 for Neurogenic Shock Dx
Question: Our trauma surgeon treated a patient who had an injury caused by a motorcycle ac... Read more
You Be the Coder:
Does Gentle Manipulation Merit 25605?
Question: We recently treated a radial fracture (25600). A few days later, the patient ret... Read more
NCCI Rings In 2005 With Hundreds of Edits Affecting New Codes
The grinch comes late this year, as wound care, knee surgery bundles abound If you're jus... Read more
Joint Injection With E/M? Append -25 in These Instances
Separate diagnoses aren't necessary, but they help If your carrier has suddenly started d... Read more
If X-Ray Reread Rules Confuse You, We've Got a Remedy
Reporting second reads should be the rare exception, not the rule Just because your surg... Read more
Reader Questions:
Avoid -59 and -51 With Unlisted
Question: One of our surgeons performed a meniscus transplant (code 0014T) and an open kne... Read more
Reader Questions:
Defer to Surgeon for Cervical, Thoracic Decision
Question: Would the C7/T1 interspace be considered cervical or thoracic?Michigan Subscribe... Read more
Reader Questions:
New Patient in Hospital Is Established in Office
Question: At a recent seminar, a provider insurance representative advised me that when ou... Read more
Reader Questions:
Look to 733.99 for Gorham's Disease
Question: What is the ICD-9 code for a condition called "Gorham's disease"?Massachusetts S... Read more
Reader Questions:
1 Code Covers a Day's Work in Discharge
Question: When our physicians discharge patients from the hospital, is 99238 the only code... Read more
Reader Questions:
Don't Bill 99211 With Injection
Question: When our nurses administer injections, we usually report the codes for injection... Read more
You Be the Coder:
Do Unlisted-Procedure Codes Have Global Days?
Question: Does Medicare assign a global period for unlisted-procedure codes? For instance,... Read more
Refresh Your Fracture Care Coding With Expert Answers to 4 FAQs
Modifiers can be the key to payment Do you know your Galeazzi fracture from your buckle ... Read more
RVU Update:
Expect an 8 Percent Raise for G0289 Charges
2005 Fee Schedule offers some gains, but a few big losses, too The good news: CMS has rel... Read more
Chart the Changes to the 2005 RVUs That Will Affect Your Bottom Line
Medicare's 2005 Physician Fee Schedule may impact your reimbursement more than you expect ... Read more
News You Can Use:
New Meniscal Transplant Code Pays Nearly $1,700 in 2005
But new wound VAC codes won't bring in any reimbursement Medicare's 2005 Physician Fee S... Read more
Reader Questions:
Choose Unlisted for Peroneal Sheath Aspiration
Question: Our orthopedist entered the peroneal sheath and aspirated fluid. I can't determi... Read more
Reader Questions:
Appeal When Payers Don't Recognize -59
Question: I have difficulty collecting for arthroscopy of the glenohumeral joint (29822) w... Read more
Reader Questions:
Only Bill G0289 to Private Payers When Directed
Question: We performed a right knee medial meniscectomy, along with chondroplasty of the p... Read more
Reader Questions:
Combine ED Visit With Admission
Question: When our orthopedist admits a patient to the hospital after-hours from the emerg... Read more
Reader Questions:
Avoid 26535 for the Toe
Question: Is code 26535 limited strictly to the hand, or can we use it for an interphalang... Read more
You Be the Coder:
Do Aircasts Differ From Splints?
Question: Does an aircast qualify as a splint?       &n... Read more