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Orthopedic Coding Alert

Steer Clear of Traumatic Hip Dislocation's Hidden Traps
At $276 extra a pop, understanding -requiring anesthesia- is worth the effort To choos... Read more
2 Tips Round Out Your Hip Dislocation Know-How
Search beyond trauma codes for spontaneous and post-THR reductions CPT and ICD-9 both ... Read more
'Consult Plus'? Turn to These Examples for Coding Success
Watch the global period to help clue you in to the proper modifier Mastering consult co... Read more
Don't Code Another Consult Until You Learn These Rules
Whether you count to 3 R's or 5, be sure you meet all requirements You-ve got advice on... Read more
Reader Questions:
Obesity May Not Merit Mod 22
Question: Should I append modifier 22 for bimalleolar fracture treatment when the patien... Read more
Reader Questions:
Running Late? Don't Use 99050
Question: If our office hours are 8 a.m. to 5 p.m., Monday to Friday, but the surgeon ru... Read more
Reader Questions:
Simplify Abscess Coding
Question: My surgeon saw a patient in consultation at the hospital. A portion of the doc... Read more
Reader Questions:
Remember E Codes for Workplace Accident
Question: Which diagnosis codes should I report for a patient who fractured two metacarp... Read more
You Be the Coder:
Select Proper Mesoacromion Code
Question: What is the correct coding for a mesoacromion repair? We have been using the u... Read more
Scope Out 5 Can't Miss Tips for ACL Coding
Knee surgeons starting to use pain pumps? Check question 3 As many as 300,000 American... Read more
Fill in the Blanks to Boost Your Unlisted Procedure Pay
Get your surgeon's John Hancock to put your best foot forward When you-re reporting ACL... Read more
Ace Teaching-Physician Coding to Keep Deserved E/M Dollars
Don't forget this modifier to show who provided services You can ensure that your ortho... Read more
News You Can Use:
Did You Omit KX on PT Claims in July? Resubmit Today
Extended exceptions come just late enough to cause more work If your practice provides ... Read more
An article in Orthopedic Coding Alert Vol. 11, No. 6, "Replace 29877 With G0289 for... Read more
Reader Questions:
Don't Expect CMS to Cover TIPs
Question: A previous Orthopedic Coding Alert mentioned that CMS was considering coverage... Read more
Reader Questions:
73110 Covers 5-View X-Ray
Question: If the orthopedic surgeon interprets three views of a patient's wrist, plus po... Read more
Reader Questions:
Check Separate Incision for 20900
Question: Which codes should I use for a TKA with structural bone grafting of the latera... Read more
Reader Questions:
Mod 59 Best for Separate Sites
Question: If a patient has joint injections in her right shoulder and right hip on the s... Read more
Reader Questions:
Choose 715.3X for This OA Case
Question: What should I look for in the documentation to distinguish primary and seconda... Read more
You Be the Coder:
Match Monteggia Codes to This Report
Question: How should I code the following report for the right elbow? Open reduction, in... Read more
Distinguish Bimalleolar and Trimalleolar Fractures Like a Pro
Find out what -medial malleolus and distal fibular fracture- really means If you limit ... Read more
Submit Clean ESI Claims Every Time -- Including the Fluoro
Payer policies reveal which conditions indicate medical necessity The next time you cod... Read more
Match ESI Codes to Proper Vertebrae at a Glance
Remember to watch for trans-foraminal or translaminar approach You have a lot of elemen... Read more
Reader Questions:
Collect for 22214, Not 0171T
Question: If the surgeon performs a lumbar spine oste-otomy (22214) and places an X-STOP... Read more
Reader Questions:
Match Claims to Medicare's G0289 Guidelines
Question: We are trying to get a large loose body (over 5 mm) removal paid that occurred... Read more
Reader Questions:
Keep Mod 50 Off of Bilateral Laminectomy Claim
Question: If the surgeon performs a bilateral lumbar laminectomy, should I append modifi... Read more
Reader Questions:
Get a Grip on Global Rules
Question: A surgeon who isn't in our group performed a left total hip replacement three ... Read more
You Be the Coder:
Decide When to Apply 20931
Question: May I report 20931 for a structural allograft related to open reduction, inter... Read more
Rise to the Wrist Fracture Coding Challenge With This Case Study
Warning: One documentation slip could lead to a $216 mistake Ignore the number of fract... Read more
4 Common Hip Labral Tear Situations Solved
Simplify choosing comparison codes with these expert suggestions You may only be able ... Read more
Reader Questions:
CCI Says 27446 With 27438 Is OK
Question: I have a physician who is doing a medial unicompartmental replacement and a pa... Read more
Reader Questions:
Watch Pin Removal Place of Service
Question: One of my surgeons is billing out an in-office pin removal during the post-op ... Read more
Reader Questions:
Follow Payer's 29876, 29881 Preference
Question: I-ve been hearing conflicting advice regarding whether I may report 29876 with... Read more
Reader Questions:
Spine Cystectomy May Merit 63030
Question: My surgeon performed an L4-L5 foraminotomy and synovial cyst removal. The diag... Read more
Reader Questions:
Include Subscapularis Portal in 29827
Question: My surgeon performs a subscapularis repair to the lesser tuberosity with one a... Read more
Reader Questions:
Count Levels for Arthrodesis
Question: Should I report four units of arthrodesis when the surgeon fuses vertebrae L2 ... Read more
You Be the Coder:
Re-Examine Re-Exploration Definitions
Question: Is there any guideline on when to use 63042 based on the previous surgery date... Read more
Make the Switch to 2009 Orthopedic ICD-9 Codes as Easy as 1, 2, 3 -- Here's How
Added wound repair notes will help keep you on top of your coding game You can get a he... Read more
Be the First to See Orthopedic ICD-9 Codes Under Discussion
Dural tears may get the spotlight in next year's new codes As if the more than 330 pote... Read more
Master Modifier 78 Guidelines to Boost Complication Coding
Don't shortchange your -return to the OR- fee When complications from an initial proced... Read more
Guest Columnist:
Beth P. Janeway, CPC, CCS-P, CCP: Ace Orthopedic Anatomy and Watch Your Accuracy Rate Rise
Use this spine anatomy tip to simplify your coding What's so difficult about coding for... Read more
Reader Questions:
Count on 27299 for Hip Decompression
Question: I report hip core decompression with bone grafting with an unlisted-procedure ... Read more
Reader Questions:
Avoid Ganglion Code for Baker's Cyst
Question: Which CPT code applies to aspiration of a Baker's cyst? Connecticut Subs... Read more
Reader Questions:
Require CTS Diagnosis for 354.0
Question: After an initial consult, our orthopedic surgeon documented suspected carpal t... Read more
Reader Questions:
Try 11043 for Achilles Tendon Service
Question: May I report 11043 for Achilles tendon debridement? The surgeon documented rem... Read more
Reader Questions:
Break Down Tenotomy Options
Question: Which CPT code should I report when the surgeon documents treating mallet toe ... Read more
Reader Questions:
Add Modifier AS to Assistant's Claim
Question: When should I append modifier AS to a CPT code? Kansas subscriber Answer: ... Read more
Reader Questions:
Try 726.4 for This Overuse Injury
Question: What ICD-9 code should I report for intersection syndrome of the wrist? Michi... Read more
You Be the Coder:
Take on TKR With Revision
Question: If the surgeon performs a total knee replacement (TKR) but during surgery deci... Read more
CCI 14.1:
Cut This Osteotomy Code Out of Your 0171T Claim to Prevent Payment Delays
Plus -- edits take aim at palm and finger excisions The Correct Coding Initiative (CCI... Read more
News You Can Use:
Beef Up Pay for Bilateral Peripheral Nerve Injection
The latest CCI edits aren't the only April 1 change affecting you Reimbursement for man... Read more
Elbow in Focus:
Clean Up Your Collateral Ligament Claims -- Here's How
Does 841.0 belong with 24346? This terminology tip clears the confusion You-ve got your... Read more
Clip and Save:
Use This Diagram to Elbow Aside Collateral Ligament Snafus
Boost your coding proficiency with this at-a-glance tool When you-re coding elbow coll... Read more
E/M Corner:
Keep Your Accuracy Rate High -- Inpatient Coding Tip
Hint: Fight the temptation to equate ICU with critical care Critical care codes sport h... Read more
Reader Questions:
Navigate 20985 With Patient Discussion
Question: We-ve been getting denials for navigation code 20985. Should we be doing somet... Read more
Reader Questions:
Keep Track of Refills for E/M
Question: May we bill an insurance carrier for a prescription refill outside the global ... Read more
Reader Questions:
Check Out Same-Specialty Consult Guidance
Question: In our orthopedic practice we have two family practice physicians who are boar... Read more
Reader Questions:
Second Spacer Takes 27299
Question: The surgeon removed an infected spacer and inserted a new spacer at the same e... Read more
Reader Questions:
Code Consult, X-Ray and Injection
Question: Our orthopedic surgeon performed a consult for a new patient who has had left ... Read more
Reader Questions:
Verify Whether Op Report Should Say 'Open'
Question: Which CPT code should I report for this physician's note? He documented: Left ... Read more
Reader Questions:
Include 28232 in 28285?
Question: How should I report arthroplasty and flexor tenotomy of the left fourth toe? ... Read more
Reader Questions:
Remember 2008 Supartz Switch
Question: How should I report Supartz injection in the right knee? Arizona Subscriber ... Read more
You Be the Coder:
See if Plantar Fasciitis Visit Earns E/M
Question: A patient returns for re-evaluation of her plantar fasciitis and a second cort... Read more
Osteochondral Autograft or Allograft? This In-Depth Look Helps You Decide
Don't miss what the term -autograft(s)- reveals for 27416 and 29866 CPT 2008 brought yo... Read more
Test Your New Knee Coding Skills With This Report
Decide which osteochondral graft code this OATS procedure earns Knowing the theories be... Read more
Snap Up Spinal Bone Graft Payment With Add-On Tips
Find opportunities with arthrodesis and instrumentation procedures If you missed that s... Read more
Guest Columnist:
Alice Marie Reybitz, RN, BA, CPC, CPC-H: Apply These Surefire Tips for 90-Day Global Period Success
Think there really are 90 days in this period? Find out the truth The 90-day global sur... Read more
Reader Questions:
Match Proper CPT to McLaughlin Procedure
Question: I have a report specifying a combined approach McLaughlin procedure for a pati... Read more
Reader Questions:
Don't Delay Closed Treatment Reporting
Question: My surgeon would like to charge for closed treatment (fracture care, no manipu... Read more
Reader Questions:
Coracoplasty Merits 29999
Question: I have a report for an arthroscopy for subacromial space decompression (29826)... Read more
Reader Questions:
No Disruption = No 99058
Question: If a patient calls in with an emergent issue, but the surgeon just uses an ava... Read more
Reader Questions:
Include Pain Pump in Global Fee
Question: How should I report pain pump application with a left shoulder arthroscopy? M... Read more
Reader Questions:
Base Block Coding on Levels, Not Nerves
Question: Our surgeon documented that he administered a nerve block to the left side of ... Read more
Reader Questions:
Replace 29877 With G0289 for Smooth Sailing
Question: I work for an ASC, and Medicare denies 29877 when it's on a claim with 29880 o... Read more
You Be the Coder:
Size Up Subtalar Codes
Question: Which CPT codes should I report when the surgeon performs two manipulations un... Read more
Case Study:
Spot What's Missing to Prove You're a Lesion Excision Coding Ace
This foot-mass report requires you to dig deep for both CPT and ICD-9 The reports you r... Read more
3 Steps Steer You Clear of Excision Coding Snafus
Example 2 reveals why you need to watch for the narrowest margin When patients with le... Read more
Advanced Lesson:
Are You Up to Speed on CCI 14.0 Changes? Find Out Fast
3 questions help you get a grip on the most recent edits Still trying to digest all the... Read more
Guest Columnist:
Leslie Johnson, CPC: Pull From the 'Coding Toolbox' to Understand Payer Policies
NCDs and LCDs can light the path to a clean claim New coders soon learn that there is m... Read more
Boost Your ABN Efficiency With NCD Know-How
3 steps help you use payer policies to your advantage Deciding when to get patients to ... Read more
Next Time You Wonder About Coverage, Check Out This List
Have osteoarthritic knee patients? See number 3 Here's a look at some of the national c... Read more
Watch for NCD Works in Progress That Affect Your Services
If your practice wants coverage, here's how to speak up CMS alerts providers when it's ... Read more
Reader Questions:
Failed Reduction Merits Modifier 52
Question: The orthopedic surgeon saw a patient in the emergency department for a medial ... Read more
Reader Questions:
Report 20950 per Extremity
Question: How should I bill compartment pressure measurements? Louisiana Subscriber ... Read more
Reader Questions:
Stick to 29881 for Saucerization
Question: What is the proper way to report saucerization of a lateral discoid meniscus? ... Read more
Reader Questions:
Follow the '72285 Includes 77003' Rule
Question: May I report CPT 77003 and 72285 together for the same service? A coworker to... Read more
Reader Questions:
Pick Apart 'Primary' vs. 'Secondary'
Question: For codes such as 27695, 27696 and 27698, what do the terms "primary" and "sec... Read more
Reader Questions:
1 Code Reports Tib and Fib Treatment
Question: What CPT codes should I report if the surgeon inserts a rod in the tibia for a... Read more
Reader Questions:
Check CMS Site for HCPCS Updates
Question: When do 2008 HCPCS codes go into effect? I thought it was Jan. 1, but I heard ... Read more
You Be the Coder:
Tackle 25606 and 25607 Bundle
Question: One of our physicians did an "open reduction and percutaneous pinning of the r... Read more
5 Clues Help You Reap Hundreds of Dollars on Every 20692 Claim
-Olive wire- will give you the answer you need every time If your surgeons use the term... Read more
Let This Guide Help Pinpoint 20690 and 20692 Clues
Compare uniplane and multiplane op report indicators The next time you-re struggling to... Read more
2008 Update:
Did You Catch the Modifier 51 Change for 20692?
Here's the truth behind why CPT removed this code from Appendix E In CPT 2008, you won'... Read more
CPT 2008 Drives Multiple Orthopedic CCI Edit Changes
Ex fix dominates deleted edits Correct Coding Initiative (CCI) version 14.0, effective ... Read more
Q4050 Could Boost Your Claim by $50:
Here's How
But heed payers- A and Q code preferences -- or pay the price Suppose a practitioner in... Read more
Guest Columnist:
Douglas Jorgensen, DO, CPC: How to Query Your Surgeon for the Most Accurate Code
Put these timing tips to work for you Problem: Physicians and mid-level providers, scur... Read more
Do You Have a Doctor/Coder on Staff?
Another approach to making sure physicians and coders are on the same page is to have a ph... Read more
Expert Advice:
Eliminate Undercoding or Pay the Price
Communication is key to avoiding both overcoding and undercoding If you undercode, you ... Read more
Advanced Lesson:
Do the Math to Encourage Clean Claims, Documentation
Additional procedures add up fast Suppose your surgeon performs an open reduction/inter... Read more
Quick Reference:
Bookmark This Fee Schedule Site on Your Browser
Try this efficiency booster for yourself today If you need to check a code or two on th... Read more
Reader Questions:
Tackle TFCC and Ulnar Abutment Coding
Question: What is the appropriate ICD-9 code for an acute triangular fibrocartilage tear... Read more
Reader Questions:
Pick Proper Pectoralis Code
Question: Which CPT code should I report for a torn pectoralis major muscle repair? Sou... Read more
Reader Questions:
Include Notchplasty in ACL Reconstruction
Question: How should I code an arthroscopic notchplasty? The surgeon performed the proce... Read more
Reader Questions:
Global Period Doesn't Apply to Assistant
Question: If a neurosurgeon calls our orthopedic surgeon to the OR to assist, does the g... Read more
Reader Questions:
Not All 23420 Guidance Is Authoritative
Question: Are there any authoritative guidelines on when to use 23420? Rhode Island Sub... Read more
You Be the Coder:
Hunt Down Styloid Codes
Question: Which CPT and ICD-9 codes should I use for a closed ulnar styloid fracture? N... Read more
Shore Up Your Skills With This Real-Life Knee Case Study
Refresh your coding essentials with this step-by-step ICD-9 selection If you-re eager f... Read more
Whip Your X-Ray Coding Into Shape Today
Find out whether you-re a shoulder-view ace with question 2 Diagnostic imaging is the f... Read more
Whip Your X-Ray Coding Into Shape Today
Check your answers to the quiz on page 27 How did you do? Find out below. Beef Up Yo... Read more
Get Up to Speed on Synvisc Coding Saga's Latest Chapter
HCPCS 2008 gives Synvisc and Hyalgan another facelift If your head's still spinning fro... Read more
Guest Columnist:
Darlene Boschert, CPC, CPC-H, CCP, CMM, CHCO, CMT, CMA Taking the Fear Out of Modifier 59
Clinical examples help clear up common misconceptions I personally think that modifier ... Read more
Reader Questions:
2nd Stage of Reimplantation = 27132
Question: One of our orthopedic surgeons did a planned reimplantation of a total hip rep... Read more
Reader Questions:
Unspecified Ganglion Merits 727.43
Question: Which ICD-9 codes should we report for a patient who had surgery addressing ca... Read more
Reader Questions:
Bolster Your Splinting/Strapping Know-How
Question: What are the keys to deciding when to report splinting and when to report stra... Read more
Reader Questions:
Stick to 20605 for Sacrococcygeal Injection
Question: What's the proper way to code a sacrococcygeal joint injection? Michigan Subs... Read more
Reader Questions:
Clamp Down on Consult Miscoding
Question: If a managing physician asks the orthopedic surgeon for a consult on an inpati... Read more
Reader Questions:
Blood Vessel Repair Merits 35236
Question: What CPT code should I report if the orthopedic surgeon had to perform a radia... Read more
Reader Questions:
Clear Away Debridement Questions
Question: May I bill debridement if the physician documents no gross contamination? The ... Read more
Reader Questions:
Snag Separate PLIF and Laminectomy Pay
Question: My surgeon argues that we should be able to report a laminectomy (63047) in ad... Read more
Reader Questions:
Still Confused About Mods 59 and 51? Read This
Question: My colleague and I have been debating the proper times to use modifiers 59 and... Read more
Reader Questions:
You Don't Need 59 for This Surgery Combo
Question: May I report all three surgeries when the physician performs a torn anterior c... Read more
You Be the Coder:
Routine Hip Follow-Up May Require 2 Codes
Question: Which diagnosis code should we report for a patient who comes in for a routine... Read more
AMA Update:
CPT 2008 Delivers Specificity With New Tenotomy, Fracture Care Codes
Plus: Mosaicplasty gains a code, modifier descriptors are overhauled CPT 2008 is the or... Read more
CPT 2008:
Prepare for New Modifier Descriptors in the Coming Year
Unusual or increased? Your modifier 22 use now depends on the difference The new muscul... Read more
Identify Key Differences When Billing SLAP Repairs
Differentiate between 29806 and 29807 and you-ll find the right code Don't let SLAP les... Read more
Guest Columnist:
Bill Mallon, MD: Speak the Language of Fractures, and Your Coding Will Improve
Know the right clinical terms, and the codes will follow Healthcare providers often dis... Read more
Reader Questions:
Know Definition of 'Maintenance Therapy'
Question: Our insurers don't allow us to pay for "maintenance therapy." But where should... Read more
Reader Questions:
Avoid Fracture Care Code Without Fx
Question: If our physician sees a patient in the office and dictates that the patient do... Read more
Reader Questions:
Get the Scoop on Saucerization
Question: Our surgeon performed a saucerization of the lateral discoid meniscus, but I d... Read more
Reader Questions:
Differentiate Reconstruction From Repair
Question: Our surgeon performed a left knee medial collateral ligament reconstruction. W... Read more
Reader Questions:
Report 49215 for Sacral Excision of Tumor
Question: Our physician performed a sacral tumor excision, which required him to remove ... Read more
Reader Questions:
Consider Consult Codes for Inpatients
Question: One of our surgeons consulted a Medicare patient in the hospital for a recurre... Read more
Reader Questions:
OIG Will Be Watching in 2008
Question: I recently heard that the Office of Inspector General plans to focus on incide... Read more
You Be the Coder:
What's the Outlook on Splint, Cast Supply Pay?
Question: We-ve been hearing that our cast and splint supply payments will go up for 200... Read more
Success Story:
7 Steps Help You Collect X-Ray Reimbursement for SNF Patients
Consolidated billing may be a hurdle, but these practices triumphed and collected their ... Read more
Do You Have a Success Story?
If you-ve recently battled denials or collected on appeal, we-d love to share your success... Read more
Why the Split Billing?
The Balanced Budget Act of 1997 requires SNFs to consolidate their billing for Medicare be... Read more
No Modifier Will Overcome CCI 13.3's Hundreds of Edits
Avoid spinal surgery denials by paying attention to CCI changes You can pretty much giv... Read more
Quick Knee Arthroscopy Coding Tips Simplify Claims
Bypass this simple chondroplasty coding mistake that can cost you When the surgeon perf... Read more
Ensure Contract Negotiation Success With 3 Key Steps
Clarify fee schedules or risk lost reimbursement Reading the fine print doesn't just ap... Read more
Use This Checklist to Overcome Contract Negotiation Challenges
10 tips can prevent carrier hassles Carrier contract negotiation is often a long, diffi... Read more
Clip and Save:
Find Out Your Rights Before You Sign a Payer's Dotted Line
Ask these questions to get started on your way in contract negotiations When you-re thi... Read more
Reader Question:
Consider 28300 for Evans Procedure
Question: Our surgeon is a foot and ankle specialist, and he did an Evans procedure (lat... Read more
Reader Question:
Avoid Undercoding Your Claims
Question: I keep hearing that undercoding is just as dangerous as upcoding, but no one c... Read more
Reader Question:
Deconstruct Acronym for ASIS Avulsion Code
Question: Which diagnosis code should I report for an ASIS avulsion? Texas Subscriber ... Read more
Reader Question:
Trephination Isn't Just for the Skull
Question: What is trephination, and how should I code for an arthroscopic knee trephinat... Read more
You Be the Coder:
Can Consult Report Be Part of Shared Record?
Question: Consult rules state that the consulting physician must send a written report o... Read more