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Orthopedic Coding Alert

Combat Hip Coding Confusion With a Few Simple Expert Tips
Understand eponyms, acronyms and unlisted-procedure coding rules to make your claims spa... Read more
Use This Chart to Select the Right Hip Codes -- Every Time
Match the site to the documentation to choose the correct options Get to know the spe... Read more
Take 5 to Nail Down ASC Coding Rules
Know your modifiers, allowable codes, for ASC payment The orthopedic coding community ... Read more
Open Communication Will Cut Down ASC Miscommunication
ASC and surgical coders should keep in contact In some cases, the ASC coder will rev... Read more
News Flash:
CCI 13.3 -- You Can Soon Rescue Discectomy Denials
The edit will be revoked retroactively One of the most troublesome Correct Coding In... Read more
Stick With Single Primary-Level Code for Spine Procedures
Orthopedic Coding Alert, Vol. 10, No. 9, recommended that when reporting kyphoplasty or ... Read more
Orthopedic Coding Alert Poll:
We Want to Hear Your Charge Capture Method
Do your surgeons enter their surgical CPT and ICD-9 codes on index cards and submit ... Read more
Guest Columnist:
Jill M. Young, CPC-EDS: Consultations for Orthopedists -- to Bill or Not to Bill? Is That Not the Question?
A breakdown of when you can -- and can't -- bill consults is essential for every office ... Read more
Expert Advice:
Use These Guidelines As Documentation for Consults
Real-life examples help show you the way If your physician's documentation could use ... Read more
Reader Question:
New Guidance Will Help Anterior Fusion Claims
Question: Our surgeon worked as a co-surgeon during a level-C3 spine fusion performed us... Read more
Reader Question:
Tillaux Fx Affects Distal Tibia
Question: What is a Tillaux fracture, and which codes apply to this injury? Massachuset... Read more
Reader Question:
Differentiate 23331 From 23107
Question: Our patient had a total shoulder replacement, and the glenoid component has no... Read more
Reader Question:
Consider 99358 for Video Viewing
Question: We-re working with a workers- compensation carrier that is having our physic... Read more
You Be the Coder:
What's Going on With LADR Payment?
What's Going on With LADR Payment? Question: We haven't had much luck getting authori... Read more
Shoulder Surgery Clinic:
Take a Swing at 3 Shoulder Coding Scenarios
Bonus: Learn when your physician's requests will throw your coding out of joint &n... Read more
Separate Procedures Can Be Separate -- Here's How
CCI is an important tool when you-re not sure about a bundle Warning: Don't assume a ... Read more
Shoulder Anatomy Can Be Your Key to Quick Code Selection
Learn what's where to make your coding easier Because the shoulder is highly mobile, it... Read more
Achieve CEU Goals Using Your Coding Publications
If you-re a Certified Professional Coder through the American Academy of Professional Co... Read more
Guest Columnist:
Rhonda Buckholtz, CPC: Avoid 7 Common Medicare Billing Errors -- Here's How
Take a few simple steps to ensure clean claims and proper payments The Administrative S... Read more
Clip-and-Save Bonus:
Simplify Your Place-of-Service Coding With This List
Fingertip guide to your most common POS eliminates confusion Choosing the correct pla... Read more
Brush Up on Your ICD-9 Know-How With 1 Tip
It's time to replace the outdated ICD-9 codes with the new and revised diagnosis codes, ... Read more
Reader Question:
Consult Request Doesn't Have to Name Names
Question: How specific must a consult request be? I know there must be a specific reason... Read more
Reader Question:
'One Size Fits All' Fee Schedule Isn't Required
Question: Must we bill all patients at the same rate? Pennsylvania Subscriber Answer... Read more
Reader Question:
Review Your ROS Levels
Question: What is meant by the review of systems (ROS) levels? California Subscriber ... Read more
Reader Question:
Watch Compartments for Meniscectomy/Synovectomy
Question: My orthopedist performed a lateral and medial meniscectomy and a partial synov... Read more
Reader Question:
Multiple Screws Still Only One Code
Question: My orthopedist documented that he removed three screws through three separate ... Read more
Reader Question:
Post-Op Brace Fitting and Education Is Separate
Question: Can my physician bill for a fitting and education of a brace during the postop... Read more
Reader Question:
25605 or 25606, but Not Both
Question: How should I report a closed reduction of a distal radius fracture with percut... Read more
Reader Question:
Confirm Diagnosis Before You Report It
Question: If the physician hasn't indicated x-ray results in his final diagnosis, should... Read more
You Be the Coder:
Which Code for Knee Hematoma?
Question: My orthopedist evacuated a hematoma at the prepatellar bursa on the left knee.... Read more
Why You Should -- and How You Can -- Master the 'Multiple Scope' Rule
4 strategies that every ortho coder needs to know If your orthopedist performs severa... Read more
Nail Down Terminology to Code Foot and Ankle Conditions
Once you know what each diagnosis means, finding a dx code will be a snap Don't let a... Read more
Follow 5 Rules to Help You Collect for Extra Physician Time
Watch out: There are different codes for the inpatient and outpatient settings You ma... Read more
Guest Columnist:
Linda Eickmann, CPC ~ E/M Auditing: Make Sure You Give Credit Where Credit Is Due
Be certain you know what to count when reviewing your claims Question:-What's the fir... Read more
Expert Advice:
Watch for These 10 Red Flags in Your Chart Audits
Find the trouble signs before they turn into disasters When you-re auditing your char... Read more
Reader Questions:
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture? Ohio Subscriber ... Read more
Reader Questions:
Use NEMB to Capture Self-Pays
Question: I keep hearing the term "NEMB," but I-m not exactly sure what it is. I know th... Read more
Reader Questions:
Stick With 29866 for OATS
Question: What code would I use for a knee arthroscopy with OATS procedure? In the op no... Read more
Reader Questions:
'With or Without' Includes With
Question: What exactly does "with or without internal or external fixation" mean when a ... Read more
Reader Question:
Audit Your Charts Before Authorities Do
Question: Do you have any tips for performing a coding self-audit? Mississippi Subscri... Read more
You Be the Coder:
Coding for PCL Debridement
Question: If the orthopedist debrides a ganglion cyst of the posterior cruciate ligament... Read more
6 Easy Steps Distinguish Kyphoplasty From Vertebroplasty -- and Get Your Claims Paid
Crossing spinal regions calls for more than one -primary level- code If you can't tell ... Read more
Reporting Unlisted Codes Doesn't Have to Be Painful
Follow the experts- guidance to getting these claims reimbursed CPT doesn't always ma... Read more
Crucial Points Help You Understand Unlisted Codes
You may need electronic and paper claims to get the payment you deserve Here are the ... Read more
Young Patients Mean Special Challenges -- and Special Pay
1 modifier makes all the difference - if you know when to use it correctly Treating i... Read more
Guest Columnist:
Betty Johnson, CPC, CCS-P, CIC, CCP
Minor vs. major makes all the difference Modifiers 25 and 57 are two E/M modifiers th... Read more
Checklist Eases Modifier 25 Claims
To ease payment for your modifier 25 (Significant, separately identifiable evaluation and ... Read more
Modifier 25/57 Decision Tips
Choosing whether to use modifier 25 or 57 can mean the difference between getting paid for... Read more
Reader Questions:
Watch Multiple Scope Rule for 29879 and 29881
Question: My orthopedist performed an arthroscopic medial meniscectomy and chondral pick... Read more
Reader Questions:
Check Your Modifiers for Shoulder Scopes
Question: An orthopedist in my practice arthroscopically repaired a rotator cuff on the ... Read more
Reader Questions:
Same-Specialty Docs Can Consult
Question: Can physicians of the same specialty request or receive a consult from other p... Read more
You Be the Coder:
Coding for Microfracture
Question: How should I code a microfracture on the medial femoral condyle? The orthopedi... Read more
Hip Pathophysiology 101 ~ When You Know What Can Go Wrong, You Have a Better Idea How to Code It
Make sure these ICD-9 codes are on your list of common hip ailments If your orthopedist i... Read more
3 Steps Make Sure Your Diagnosis Coding Passes Muster
Signs and symptoms may sometimes be the best -- or only -- choice Although the ... Read more
Are You Reporting 99211 Correctly? The Experts Weigh in
If you-re using it only for nurse visits, you could be losing out You may think of 99211 ... Read more
Avoid a HIPAA Violation -- Review the Basics and Stick to Them
Just because you're handing out privacy notices doesn't mean you can stop there Everyone ... Read more
Check Off This List to Prevent HIPAA Violations in Your Office
Spot problem areas and take action to protect yourself and your practice As you walk arou... Read more
Reader Question ~ Use Multiple Codes for Multiple Procedures
Question: My orthopedist performed an arthrodesis, discectomy and osteophytectomy, removin... Read more
Reader Question ~ Units Won't Make the Grade
Question: My physician's operative note says he performed an arthrodesis of the Lisfranc j... Read more
Reader Question ~ Narrow Your Patellar Reconstruction Choices
Question: My orthopedist diagnosed a patient with chondromalacia with recurrent patella su... Read more
Reader Question ~ Watch Your Modifiers on ORIF Revision
Question: One of our patients fell and pulled the screws out of a plate our orthopedist pl... Read more
Reader Question ~ Check 22855 for PEEK Cage Removal
Question: What code should I use for the removal of a PEEK cage? The surgeon isn't reinser... Read more
You Be the Coder ~ Category I or Category III?
Question: What is the difference between 76000 and 0054T, and when should I use them?Texas... Read more
Test Your Mettle With This Op Report Challenge
Watch out: Even documented procedures aren't always billable Proper coding often depends ... Read more
Use Key Terminology to Increase Your Spine Coding Savvy
Get to know the spine in-depth, and the right codes will follow Do you know your facet fr... Read more
Answer Your Vertebral Anatomy Coding Questions With This Chart
Match the site to the documentation, and you-ll choose the right code every time  If... Read more
3 Tips Make Bone Density Coding a Snap
A denial for one old code could cost you $100 per visit If you find tracking Medicare's D... Read more
Guest Columnist:
Erica D. Schwalm, CPC-GSS, CMRS---Strengthen Your Appeal Letters by Sticking to the Details
If your appeal letters do nothing more than generate more denials, it may be time to updat... Read more
Reader Questions:
Look to 27824-27825 for Salter II Fracture
Question: Which CPT code should I use for closed treatment of a distal tibia fracture or a... Read more
Reader Questions:
Compare Your Unlisted Codes With Existing Ones
Question: Our orthopedist performed what he called -arthroscopy of the left knee, partial ... Read more
Reader Questions:
Time Is the Key for FCEs
Question: Our physician is performing functional capacity evaluations (FCEs) in the office... Read more
Reader Questions:
Target Symptoms to Assign Dx Code
Question: Which diagnosis code should I use when my orthopedist's documentation indicates ... Read more
Reader Questions:
Use Category III Codes, Unless …
Question: Your April 2007 article -Avoid These 5 Computer-Assisted Navigation Pitfalls- sa... Read more
Reader Questions:
CPT Defines 'With Anesthesia'
Question: My orthopedist wants proof that when a procedure code states, -with anesthesia,-... Read more
Reader Question:
Avoid Automatic Resends
Question: When we know that the carrier has made a mistake in denying a claim, can I just ... Read more
You Be the Coder:
Multiple X-Ray Views
Question: We performed x-rays in the office for a patient with a wrist injury. We did the ... Read more
Resubmit Denied Hip Arthrotomy Claims and Collect Your Reimbursement
NCCI 13.1 deletes one edit but enacts several new ones The National Correct Coding Initia... Read more
Equip Yourself to Triumph Over Spinal Instrumentation Claims
Nail down location and instrumentation type to keep your coding on the straight and narrow... Read more
Advance Positive Fracture Care Coding Habits With Terminology
Get to know the fracture terms in-depth, and the right diagnosis and procedure codes will ... Read more
Banish NPI Hassles With This Expert Advice
Start sharing NPIs now to avoid a crunch later You have new National Provider Identifier ... Read more
Guest Columnist:
Quinten A. Buechner, MS, MDiv, ACS-FP/GI/PEDS, CPC, CCP, CMSCS: Tackle Your NPI Confusion With Expert Answers
Eliminate problems by following a few easy steps The switch to using National Provider Id... Read more
Reader Questions:
Examine Op Notes to Determine Whether Debridement Is Billable
Question: I can't determine whether it's OK to report a debridement code (11010-11012) wit... Read more
Reader Questions:
Nursing Homes Warrant Inpatient Consult Codes
Question: Is a nursing home an -inpatient- setting? Specifically, should I use the inpatie... Read more
Reader Questions:
Look to Modifier 80 for Assistant Surgeons
Question: Our surgeon performed bilateral total knee arthroplasties. He operated on the le... Read more
You Be the Coder:
How Should We Determine Dissection Amount for Muscle Biopsies?
Question: How should I determine when to use 20200 (superficial muscle biopsy) rather than... Read more
Combat Confusion About the 2007 Distal Radial Fracture Treatment Codes
Hint: Your physician's op report may cause you to select incorrect codeWhen CPT 2007 intro... Read more
Radiology Follow-Up:
Don't Let Coding Questions Delay Your Claims
Experts tackle fluoroscopy and x-ray coding challengesIf your mini C-arm device gets more ... Read more
4 Strategies Help You Collect Optimal Spine Reimbursement
Follow this advice to submit clean claims every timeSometimes, even the most seasoned spin... Read more
Expert Answers to Your Top-5 Inpatient E/M Coding Questions
Guest Columnist: Catherine Brink, CMN, CPCYou can set yourself up for clean claims and sto... Read more
7 Tips Help Keep Your Inpatient E/M Coding on the Up-and-Up
Medicare overspends millions on upcoded inpatient visitsCarriers are scrutinizing your inp... Read more
Consider 20245 for Femur Biopsy
Question: Our surgeon performed a femur biopsy, and the pathology report came back as -m... Read more
Report Just 1 Unit of 64470 per Facet Joint Nerve
In our November issue, we advised that coders should report one unit of 64470 and one unit... Read more
Bill DME Application to Insurer
Question: Our office has an outside durable medical equipment (DME) supplier that bills ... Read more
'Weber B' Describes Distal Fibula Fx
Question: Which CPT and ICD-9 codes should we report when the surgeon dictates a Weber B f... Read more
Continue Using T Code for X Stop Procedures
Question: I have been holding my claims for the surgeon's work inserting an X Stop device ... Read more
Most Co-Planing Is Included in SAD
Question: Our surgeon performed an arthroscopic bursectomy, subacromial decompression and ... Read more
Consider 24341 for Deltoid Repair
Question: Our surgeon performed an open posterior deltoid repair of the shoulder. Which co... Read more
Discover New DXA Codes
Question: Which code should I report for a DXA scan (bone density study) on a patient's la... Read more
You Be the Coder:
Fracture Codes Often Include Fixation
Question: Our surgeon performed a closed reduction with percutaneous fixation of a metatar... Read more
Avoid These 5 Computer-Assisted Navigation Pitfalls
Don't forget to send documentation with your 0054T-0056T claims Orthopedic practices incr... Read more
Recoup Reimbursement for Long-Term CTS Treatment
Documentation is the key to success  When a patient's carpal tunnel syndrome (CTS) ... Read more
3 Steps Determine New vs. Established Patient Status
Even if the patient has been to your office before, he might be new Proper billing for va... Read more
Use This Simple Tool to Determine Whether the Patient Is Really New
Answer the new-vs.-established question correctly every time Take the AMA's advice and an... Read more
YOU BE THE CODER ~ How Should We Bill Sacrococcygeal Injection?
Question: Which code should I report when the physician administers a steroid injection ... Read more
Should We Hire a Physical Therapist or Not?
Ever since CMS changed the physician -incident-to- guidelines for servicing Part B outpati... Read more
Keep This in Mind When Making Your Decision to Hire a PT
In September 2006, the South Carolina Supreme Court ruled in favor of what is known as the... Read more
5 Key Facts About the Therapy Cap You Can't Afford to Miss
Cap exceptions go fully automatic this year As many orthopedic practices know, the -thera... Read more
READER QUESTION ~ Payers May Not Accept Modifier 56
Question: We recently sent a patient to her primary- care physician (PCP) for a preoperati... Read more
READER QUESTION ~ Modifier 51 Indicates 2 Tendons
Question: Our surgeon performed a tenolysis on the peroneus brevis and longus tendons of t... Read more
READER QUESTION ~ Look to 823.00 for McKeever Fracture
Question: Our surgeon documented a tibial eminence fracture (McKeever type III). Which dia... Read more
READER QUESTION ~ Consider Treatment Type for Cubital Tunnel Syndrome
Question: Our surgeon recently treated cubital tunnel syndrome. How should we code the dia... Read more
Don't Let Tissue Scaffolding Procedures Complicate Your RCR Claims
Scrutinize the op report to determine whether the physician used a tissue scaffolding devi... Read more
Let This Chart Help You Pinpoint Appropriate Shoulder Codes
Match the site to the documentation and you-ll choose the right code every timeIf you don'... Read more
When It Comes to Synvisc, Ignore HCPCS 2007
CMS deletes brand-new Synvisc/Hyalgan drug code before it takes effect Orthopedic coders ... Read more
NCCI 13.0 Grabs on to New CPT Codes and Institutes Edits
The new edition of NCCI targets surgical codes With more than 9,000 changes in the latest... Read more
Your Physician's Notes Reveal Diagnosis Codes:
You Just Have to Know Where to Look
If the surgeon does not circle a diagnosis, it may be up to you to find one Don't let an ... Read more
LESLIE FOLLEBOUT, CPC ~ When the Superbill Lacks Data, Turn to the Documentation
Carefully read the physician's notes to extract ICD-9 codes In the perfect coding ... Read more
Can You Choose the Right ICD-9 Code for This Lesion?
Read the physician's documentation and put your diagnosis coding skills to the test Now t... Read more
Nail Down Supervision Levels
Question: Our carrier asked us to verify that our tech performed a patient's elbow MRI und... Read more
Don't Avoid Unlisted
Question: Our surgeon documented a repair of the gluteus medius tendon to treat a tear in ... Read more
Insurers May Balk at Paying Multiple Units of 77002
Question: When we perform multiple joint injections at the same time, can we report 77002 ... Read more
Include 'Caine' Drug in Injection Pay
Question: Our physician injected marcaine into a patient's knee, but I cannot find a code ... Read more
Which Arthritis Code Should We List First?
Question: How should I code a diagnosis of arthritis if an underlying cause is indicated (... Read more
SUCCESS STORY ~ Coder Wins Back $300,000 in PLIF/Fusion Reimbursement
Fight those spine bundle denials whenever possible You may have won out over edits that m... Read more
Get Your E/M Coding on the Straight and Narrow This Year
Determine how many body systems you must examine to qualify for 99214 If your practice's... Read more
CPT 2007 UPDATE ~ Discover the Details of the New Disc Arthroplasty Codes
Insurers expect you to use the new codes by Jan. 1 If you-re still reporting 0091T for yo... Read more
Get a Leg Up on Coding for Knee Arthroscopy
Find the answers to top-5 questions Knee arthroscopy is a surgical technique whereby... Read more
Experts' Techniques Make Coding RCR Easy
Knowledge of anatomy is crucial When you have a solid idea of where the shoulder parts a... Read more
YOU BE THE CODER ~ How Should We Report Gamekeeper's Thumb?
Question: Which codes should we report for a Gamekeeper's thumb repair? Arkansas ... Read more
READER QUESTION ~ Dissociation May Not Be Dislocation
Question: Our physician performed an open reduction and pinning of a scapholunate dissoc... Read more
READER QUESTION ~ Update Your Diagnoses for X-Ray Billing
Question: I recently heard that the ICD-9 guidelines for billing x-rays were updated but... Read more
Eliminate Your No-Show Headaches With These Strategies
Make sure your carriers don't frown on payment penalties Every office has them -- pa... Read more
No-Show Charge Is a No-Go Without Patient Notification
Most offices give patients 1 -free- no-show When a patient does not show up for a schedul... Read more
Let Patients Know Your No-Show Policy Up-Front With These Tools
Use a series of letters to explain the consequences of missed appointments Make all of yo... Read more
READER QUESTION ~ Ask for Details With Patellaplasty
Question: Our physician documented a patellaplasty, but I cannot find any codes for this p... Read more
Question: Our physical therapist used TENS application but did not document how much time ... Read more
READER QUESTION ~ Separate Knee Compartments Earn Separate Codes
Question: Our surgeon performed a unicondylar knee replacement on a patient. During the sa... Read more
READER QUESTION ~ Stick With 1 Code for Radial Head Arthroplasty
Question: Our physician documented open treatment of a radial head fracture with radial he... Read more