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Orthopedic Coding Alert

Coding Rules:
Coding 29805, 29806, 29807, 29819? Master the 'Multiple Scope' Rule
Adhere to the four strategies that every ortho coder needs to know. If your orthopedist p... Read more
Hips:
27033, 27125, 27132: We've Got the Answers to Your Top 3 Hip Coding Questions
Find out if you can report an osteotomy with a previous hip surgery conversion to total hi... Read more
Base Code Cheat Sheet
Find the 'Base' Arthroscopic Procedure Fast If you want to find the "base" code for a giv... Read more
Denials Management:
Overcome MUE Denial Challenges By Busting 4 Common Myths
If you ignore the medically unlikely edits, you're asking for a claim rejection. If you're... Read more
Reader Questions:
Stick With 23472 for Reverse Shoulder Arthroplasty
Question: Which code should we report for a reverse total shoulder arthroplasty? Answe... Read more
Reader Questions:
Consider 27630 for Achilles Lesion Excision
Question: Our surgeon documented an excision for thickening of the Achilles tendon, and d... Read more
Reader Questions:
780.99, 729.1, 724.2: Get Specifics When Billing Chronic Pain
Question: Which diagnosis code should I report for chronic pain? Answer: The term "chroni... Read more
Reader Questions:
Check Restorative Status Before You Bill 29540
Question: Can we report 29540 for strapping with other procedures, such as fracture care,... Read more
You Be the Coder:
Report 27447 Once When First Procedure Fails
Question: Our surgeon performed a total knee replacement, but after the glue hardened, th... Read more
CPT 2011:
22551, 22552 Enhance Your Arthrodesis Accuracy
Check out 4 new neurostimulator codes coming your way for Jan. 1.Additional neurostimulato... Read more
CPT 2011:
99224, 99225, 99226 Solve 'Middle Day' Code Dilemma
Observation services expansion eliminates payer coding variation.In 2011, coders will have... Read more
News You Can Use:
CMS Slashes 2011 Conversion Factor and Wreaks Havoc on Your Pay
Plus: Learn two new HCPCS codes if your physician performs wellness visits.Get ready for a... Read more
Knees:
Count Correctly to Keep Hyaluronic Acid Injections on Track
Timeframes, types of medications dictate your coding.Physicians administer hyaluronate or ... Read more
Correction
In the volume 13, number 6 issue of the Orthopedic Coding Alert, code 20610 (Arthrocentesi... Read more
Reader Questions:
Can Provider Change Tax ID?
Question: One of our physicians wants to stop billing under the group's tax ID and start b... Read more
Reader Questions:
29880, 29875: Watch Compartments for Meniscectomy/Synovectomy
Question: My orthopedist performed a lateral and medial meniscectomy and a partial synovec... Read more
Reader Questions:
20670, 20670: Multiple Screws Still Only One Code
Question: My orthopedist documented that he removed three screws through three separate in... Read more
Reader Questions:
27301, 10160: Which Code for Knee Hematoma?
Question: My orthopedist evacuated a hematoma at the prepatellar bursa on the left knee. H... Read more
Reader Questions:
Confirm Diagnosis Before You Report It
Question: If the physician hasn't indicated x-ray results in his final diagnosis, should I... Read more
You Be the Coder:
20205, 20200: Make the Superficial Versus Deep Distinction
Question: How should I determine when to use 20200 (superficial muscle biopsy) rather than... Read more
CPT 2011:
CPT 2011 to Debut Codes for Hip Arthroscopy, Subsequent Observation Care
Check out this sneak peek to get a glimpse of the codes you'll be using in January.If you'... Read more
Kyphoplasty vs. Vertebroplasty:
Don't Miss Out on Ancillary Procedures With Kyphoplasty, Vertebroplasty
Report radiologic supervision and interpretation, but skip bone biopsies.When your orthope... Read more
OIG Update:
Practices Collected Over $8 Million for Services Rendered After Patients Died
OIG identified massive overpayments for services rendered after patients' dates of death.Y... Read more
Reader Questions:
99231 to 99233, 99238 to 99239: No Inpatient Contact =
Question: I read "When reporting discharge day management service, you must provide and do... Read more
Reader Questions:
Symbols and Chart Explain V Code Order
Question: What rules apply to reporting V codes with E/M office visits?Can we report scree... Read more
Reader Questions:
Resolve Secondary Payer Issues With Conversations
Question: Our doctor performed surgery on a patient 11 months ago. We just learned that th... Read more
Reader Questions:
22852, 20680, 22849: Reinsertion Status Guides Screw Removal Code
Question: What CPT code should we use for removal of broken iliac screws?Maine Subscriber ... Read more
You Be the Coder:
Adhere to These 0213T to 0218T Edits
Question: My physician is hoping to start using the new paravertebral facet joint injectio... Read more
X-ray coding:
Boost Your Bottom Line By Reporting X-Rays During the Global Period
Warning: Depending on how many x-rays you write off, you could be losing thousands.My... Read more
Coding Tips:
Coding Tips:
Consider debridement a separate procedure from 26500 only when gross contamination require... Read more
Documentation:
 Watch Out: Nurse's History Note Might Be Audit Bait
The physician must indicate that he or she reviewed any nurse's notes.Warning: Don't let y... Read more
Unlisted Procedures:
Reporting Unlisted Codes Doesn't Have to Be Painful
Follow the experts' guidance to getting these claims reimbursed.CPT doesn't always match u... Read more
PECOS:
Avoid Rejected Claims by Becoming PECOS-Certified
Medicare postpones July 6 implementation and works to streamline enrollment process.You do... 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:
Appeal When Payers Don't Recognize 59
Question:I have difficulty collecting for arthroscopy of the glenohumeral joint (29822) wh... Read more
Reader Questions:
Combine ED Visit With Admission
Question:When our orthopedist admits a patient to the hospital after-hours from the emerge... Read more
Reader Questions:
Do Aircasts Differ From Splints?
Question:Does an aircast qualify as a splint?California Subscriber Answer:No. Placing a pa... Read more
You Be the Coder:
Defer to Payer for Cervical, Thoracic Decision
Question: Would the C7/T1 interspace be considered cervical? Michigan Subscriber A... Read more
Shoulders:
Get on the Fast Track to Shoulder Claim Success By Tackling These 3 Scenarios
Bonus: Learn when your physician's requests will throw your coding out of joint. T... Read more
Anatomy:
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 is... Read more
Auditing:
Check Your HPI, Risk IQ With Pre-op Exam Case Study
Hint: Your orthopedist's recs are the ones to count under mgt options.When a patient needs... Read more
Auditing:
MDM : Weigh Surgical Risk to Snag the Correct E/M Level
These definitions take the mystery out of moderate vs high surgical management options.If ... Read more
Reader Questions:
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture?Ohio SubscriberAnswer... 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 note... Read more
Reader Questions:
'With or Without' Includes With
Question: What exactly does "with or without internal or external fixation" mean when a CP... Read more
Reader Questions:
Coding for PCL Debridement
Question: If the orthopedist debrides a ganglion cyst of the posterior cruciate ligament... Read more
Reader Questions:
Consider 20245 for Femur Biopsy
Question: Our surgeon performed a femur biopsy, and the pathology report came back as... 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:
Time Is the Key for FCEs
Question: Our physician is performing functional capacity evaluations (FCEs) in the office... Read more
Reader Questions:
Avoid Automatic Resends
Question: When we know that the carrier has made a mistake in denying a claim, can I just ... Read more
Reader Questions:
Multiple X-Ray Views
Question: We performed x-rays in the office for a patient with a wrist injury. We did the ... Read more
You Be the Coder:
Check Your Modifiers for Shoulder Scopes
Question: An orthopedist in my practice arthroscopically repaired a rotator cuff on the le... Read more
Spinal Surgery:
Location -- Rather Than Type -- is Instrumental in Your Spinal Instrumentation Claims
Get the lowdown on these add-ons the surgeon might use to aid arthrodesis.Coders can trip ... Read more
Foot:
Coding Feet and Ankles? Tackle This Condition Terminology
Have these modifiers handy to distinguish areas of the feet and toes. Don't let an... Read more
Coding Quiz:
Eradicate Errors by Filling in These Diagnosis Code Blanks
Find out if you can report an E code as a primary diagnosis.Sometimes it may seem as if th... Read more
Reader Questions:
Use Healing Status to Select V Code
Question: Our patient had a hip replacement and returned one year later for a routine foll... Read more
Reader Questions:
Look to G Code for Medicare Dermabond Repairs
Question: An elderly patient of ours presented with a 1.4-cm skin tear on his left thigh. ... Read more
Reader Questions:
Include Prescription Writing in E/M
Question: I recently attended a seminar in which the presenter said we can bill a particul... Read more
Reader Questions:
72196 Covers LS Spine MRI
Question: How should I code "MRI of LS spine and sacrum and coccyx"? My radiology tech doc... Read more
You Be the Coder:
Check Out These New Emerging Technology Codes
Question: I heard the new Category III codes came out. Is there anything I should know for... Read more
Shoulders:
Think You Can't Ever Report 29806 With 29807? Think Again
Procedure and documentation could add RVUs to your claim.Your orthopedist completes an art... Read more
Knees:
Count Correctly to Keep Hyaluronic Acid Injections on Track
Timeframes, types of medications dictate your coding.Physicians administer hyaluronate or ... Read more
Documentation:
Follow These 4 Steps to Unlisted Procedure Success
Remember payer guidelines to choose accurate comparisons.When your orthopedist performs an... Read more
Reader questions:
Opt for 716.16/905.4 Combo Over V Code
Question: A patient has early post traumatic arthritis and early degenerative joint diseas... Read more
Reader questions:
Choose 726.79 for Retrocalcaneal Exostosis With Bursitis
Question: What procedure and diagnosis codes should we submit for retrocalcaneal extosis w... Read more
Reader questions:
Verify 20693 or 20999 for Halo Vest Adjustment
Question: The orthopedic surgeon adjusted a misaligned halo vest under anesthesia. He late... Read more
Reader questions:
Check 27535, 20692 for Multi Reduction, Fixation
Question: Our orthopedist completed several procedures during the same operative session: ... Read more
Reader questions:
Turn to 97605, 97606 for Postop Wound Vac
Question: Our provider completed a postoperative wound-vac change in the office. Can we bi... Read more
Reader questions:
Count Regions to Determine Debridement Level
Question: The physician's notes state, "Bursal side rotator cuff showed fraying diffusely,... Read more
Reader questions:
Open/Closed and Acute/Chronic Set Suprascapularis Code
Question: What is the correct code for suprascapularis tendon repair?Minnesota SubscriberA... Read more
Reader questions:
719.41 Could Be Peri-Scapular Pain Diagnosis
Question: What is the correct diagnosis code for peri-scapular pain?Wisconsin SubscriberAn... Read more
Reader questions:
27220 or 27899 for Tibial Nonunion Fracture
Question: The physician completed a take-down of a tibial nonunion fracture and placed an ... Read more
Reader questions:
No Modifier 26 for Your Own Equipment
Question: The physician used our X-ray equipment in the office to place the needle prior t... Read more
Reader questions:
Different Problem Doesn't Mean 'New' Patient
Question: One of our surgeons has subspecialty credentials for elbow to finger procedures.... Read more
You Be the Coder:
Counting Multi Trigger Finger Repairs
Question: Can we bill the procedure code twice for trigger finger repair on two fingers du... Read more
Anatomy 101:
3 Tips Organize Your Knee Arthroscopic Claims into Compartments, Common Terms, and Descriptor Details
Treatment location and diagnoses clue you in to correct code sets.If knee arthroscopy hove... Read more
Casts and Splints:
Avoid the Summertime Cast Trap of Coding Within the Global
Tip: Remember you can always report supplies, if you meet one simple test.When the weather... Read more
Modifiers:
Learn the Tricks to Untangling Differences in 58, 78, and 79
Don't miss out on extra pay when global period resets.Just because you routinely append mo... Read more
Reader Questions:
Know Terms for Arthro Healing ACL Response
Question: Does CPT have a code we can use for an arthroscopic healing ACL (anterior crucia... Read more
Reader Questions:
Watch When Comparing RVUs for 29999
Question: The orthopedist performed four procedures during the same surgery: left elbow su... Read more
Reader Questions:
Standard Bursitis Dx Apply to Sepsis
Question: We're coding for septic bursitis, but the documentation does not state the cause... Read more
Reader Questions:
Reporting 97140 Multiple Times Is Possible
Question: The physician saw a patient for cervical and lumbar problems and provided manual... Read more
Reader Questions:
List 840.8 for Acute Biceps Rupture
Question: What is the correct diagnosis code for an acute, traumatic rupture of the distal... Read more
Reader Questions:
Apply Dupuytren's Codes to PIP Pinning
Question: The surgeon completed multiple fasciotomies on the patient's right hand and pinn... Read more
Reader Questions:
Reinsertion Status Guides Screw Removal Code
Question: What CPT code should we use for removal of broken iliac screws?Maine SubscriberA... Read more
You Be the Coder:
Check Codes for Tuberoplasty With RCR
Question: Our physician's notes state that he debrided a patient's long, pointy-looking gr... Read more
CCI 16.1:
Think You Can Never Report Fluoro With Ortho Procedures? Think Again
This deletion could add $69 to your practice's bottom line--but make sure you adhere... Read more
Remember the Difference Between ME and NME Edits
CCI edits fall into two camps: mutually exclusive and non-mutually exclusive. Mutually exc... Read more
Let Treatment Method, Digit Number Direct You to Correct Dupuytren Codes
Find out why "otomy" versus "ectomy" makes all the difference. Watch your surgeon's docum... Read more
Try Your Hand at This Fracture/Fixation Case Study
Don't trip over the service you can't report. Most of your orthopedic coding cases begin ... Read more
Reader Questions:
Check for Fracture Diagnosis Before Coding Repair
Question: Our orthopedist saw a patient in the emergency department for a gunshot wound a... Read more
Reader Questions:
Choose 27698 or 27659 for Brostrom Repair
Question: The surgeon completed a modified Brostrom repair with repair of the peroneus br... Read more
Reader Questions:
Say No to 76003 With Paravertebral Injection
Question: CPT 2010 states that fluoroscopy is included with paravertebral facet joint inj... Read more
Reader Questions:
Arthro Posterior Remplissage = 29999
Question: The orthopedic surgeon completed an arthroscopic Bankart repair and arthroscopi... Read more
Reader Questions:
Separate Procedures Allow Scope and Open Codes
Question: Our surgeon completed an arthroscopic SLAP repair, acromioplasty, and distal cl... Read more
Reader Questions:
Know 57/58 Difference for Surgical Return
Question: A patient presented to the Emergency Room and the surgeon performed closed redu... Read more
Reader Questions:
Generic Code Best for Budin Toe Splint
Question: What supply code should we report for a Budin toe splint (toe straightener)? Mi... Read more
Reader Questions:
Remember G0289 for Some Patelloplasties
Question: The surgeon performed a lateral retinacular release with patelloplasty, where h... Read more
Reader Questions:
Look to 730.3x Family for Periostitis
Question: What is the correct diagnosis for "periostitis secondary to enlarged plantar co... Read more
Reader Questions:
Check Edits for Ostectomy, Osteotomy Claim
Question: The surgeon performed an ostectomy/bunionectomy and osteotomy of the fifth toe.... Read more
You Be the Coder:
Double Diagnose Heterotopic Calcification
Question: A patient underwent AC joint reconstruction due to a chronic grade-4 joint sepa... Read more
Build Bone Density Scan Success With These 3 Coding Keys
Stronger claims come from choosing correct scan types and diagnoses.Paying attention to th... Read more
Check Dx to Smooth Femoral Head Resurfacing Claims
Tip: Your doc's documentation can help you fight potential denials.CPT does not include a ... Read more
Here's Your 411 on Femoral Head Resurfacing
Understand what FHR involves and when patients benefit.An initial femoral head resurfacing... Read more
Overcome Shoulder Challenges By Learning Differences
Keep this list handy to distinguish problems and assign diagnoses.The shoulder injuries yo... Read more
READER QUESTIONS:
24341 Applies to Pectoralis Major ORIF
Question: An MRI of the shoulder and pectoralis showed a bony fragment with a pectoralis t... Read more
READER QUESTIONS:
Stay With One Knee Compartment Code
Question: The surgeon excised a flap tear and completed a partial synovectomy in the media... Read more
READER QUESTIONS:
Choose 24160 for Elbow Explant
Question: Our orthopedist saw a patient who had an extreme infection around her elbow impl... Read more
READER QUESTIONS:
I&D With Reconstruction Both Reportable
Question: The orthopedic surgeon completed an I&D for postoperative infection through... Read more
READER QUESTIONS:
Follow-Up for Another Doc = Modifier 55
Question: Our orthopedic surgeon is seeing a patient for follow-up visits after care from ... Read more
READER QUESTIONS:
CCI Allows 23470 + 23332 + Bone Graft
Question: The orthopedic surgeon performed a revision hemiarthroplasty and removed the com... Read more
READER QUESTIONS:
Count Vertebrae for Instrumentation
Question: Our surgeon performed anterior cervical discectomy at C3-C4, C4-C5,and C5-C6. He... Read more
You Be the Coder :
Severity Guides Tendon Tear Coding
Question: Our orthopedic surgeon completed a reconstruction of a posterior tendon tear. Wh... Read more
Stay in the Game With the Correct Ligament Repair, Reconstruction Codes
Remember ligament repair abbreviations to simplify elbow ligament surgery coding. Base... Read more
Conquer Confusion Over Chondroplasty Codes
Check compartments, extras for 29877 and G0289 success. Chondroplasty might be one of the... Read more
Test Yourself With Real-Life Modifier 25 Scenarios
See if you arrive at the same coding conclusions our experts recommend. Last month you le... Read more
READER QUESTIONS :
Remember 52 for TKR Revision
Question: A patient is 18 months past total knee replacement that became septic. Our orth... Read more
READER QUESTIONS :
Add J7325 to Your Synvisc Coding Family
Question: Our orthopedist is beginning to provide Synvisc injections. How do I code the m... Read more
READER QUESTIONS :
Use A4466 for Deleted Orthoses Codes
Question: How do we code an elbow support, now that L3701 is outdated? Missiouri Subscrib... Read more
READER QUESTIONS :
Report Fracture Care or Splinting -- Not Both
Question: Our hand surgeon treated a patient's metacarpal fracture and splinted the finge... Read more
READER QUESTIONS :
726.2 Is Best for General Shoulder Impingement
Question: What diagnosis code should we submit for shoulder impingement syndrome? New Mex... Read more
READER QUESTIONS :
Proximal Hamstring Repair = 27385
Question: The surgeon performed a proximal hamstring repair and stated that, "a 5.5 metal... Read more
READER QUESTIONS :
Payer Policy Dictates Microscope Coding
Question: Our surgeon used an operating microscope for dissection during single-level dec... Read more
READER QUESTIONS :
Use Current Diagnosis to Support E/M Visit
Question: A new patient sees the orthopedist because of shoulder problems. The physician ... Read more
READER QUESTIONS :
Look at 10060/10061 With 26445 for I&D, Tenosynovectomy
Question: The surgeon performed irrigation and debridement for a right hand abscess and c... Read more
You Be the Coder :
Narrow Options for Birmingham Resurfacing
Question: One of our surgeons says we should use a total hip code for Birmingham resurfac... Read more
Steer Your Way Clear Through CCI 16.0's Injection, Sedation Edits
Say goodbye to pairing paravertebral facet injections with virtually any procedure. Watch... Read more
Build a Firm Foundation for Plantar Fasciitis Coding
Keep tabs on details to help justify more extensive treatments later. Plantar fasciiti... Read more
Achieve Modifier 25 Success in Just 3 Easy Steps
Understand 'significant' and 'separate' to move in the right direction. Knowing when to r... Read more
Reader questions:
Cervical Collar Is Part of Repair Code
Question: Can we code separately for fitting a cervical collar following closed treatment... Read more
Reader questions:
27680 Could Be Best Choice for Non-Ruptured Tendon
Question: Our surgeon excised a portion of the patient's Achilles tendon, reanastomosed t... Read more
Reader questions:
Don't Count on Femoral Block Pay After Surgery
Question: One of our surgeons occasionally bills for a femoral block when he does a total... Read more
Reader questions:
Recasting During Global Period Is Legit
Question: A patient presented with a fractured ankle, which our orthopedist treated. We r... Read more
Reader questions:
Hip Injection With Fluoro -- Are Both Allowed?
Question: Our orthopedist administered a hip injection under fluoroscopy. Can I report bo... Read more
Reader questions:
Add Modifier 78 for Repeat ORIF
Question: A patient had a repeat ORIF (open reduction internal fracture) of a clavicle fr... Read more
Reader questions:
'Unlisted' Is Only Choice for Blood Cell Harvest
Question: How should we code for blood cell harvest of hemocytes? California Subscriber A... Read more
You be the coder:
Ulnar Impaction Syndrome Diagnosis
Question: What ICD-9 code should I report for ulnar impaction syndrome? North Dakota Subs... Read more