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Orthopedic Coding Alert

Build a Firm Foundation for Plantar Fasciitis Coding
Keep tabs on details to help justify more extensive treatments later. Plantar fasciiti... Read more
Diagnostic testing:
3 Coding Fundamentals Will Build Your Bone Density Scan Claim Success
Stronger claims come from choosing correct scan types and diagnoses. Paying attention ... Read more
Expand Your 355.6 Diagnosis Into Three Options in 2015
Key: Laterality becomes important.  Lesion of plantar nerve means that the patien... Read more
Get These 7 Compliance Plan Tips Straight From the OIG's Medical Director
The Affordable Care Act requires a firm compliance plan, so use these tips as a guidelin... Read more
Reader Question:
Get the Scoop on Saucerization
Question: Our surgeon performed a saucerization of the lateral discoid meniscus, but ... Read more
Reader Question:
Your Orthopedic Surgeons Can Report ED Codes
Question: An emergency department physician asked our surgeon to see a Medicare pat... Read more
You Be the Coder:
Document An Incomplete ROS
Question: When we have an established patient that comes into our office that needs... Read more
4 Steps Help You Weather These Complex Wrist Repair Coding Errors
Learn to differentiate tendon codes from nerve codes by studying your anatomy. Hand an... Read more
Fine Tune Your Decompression, Fusion Procedures With These Tips
If you always turn to 62, 80, or 81, our experts’ answer might surprise you. You... Read more
Examine How ICD-10 Shakes Up Your Shoulder Lesion Diagnoses in 2015
Find out how 726.xx expands into numerous options with different lingo. Shoulder lesio... Read more
3 Tips Analyze Your ASC Coding Rules
Here’s how to properly use modifier SG. Suppose you bill Medicare when your surg... Read more
Reader Question:
Can You Bill Digital Block Bundles With Toenail Excision? Find Out
Question: Our foot surgeon performed a toenail excision and nail bed repair with a ... Read more
Reader Question:
Cross Modifier 50 Out for Trigger Point Injections
Question: How should I report bilateral trigger point injections in three locations... Read more
You Be the Coder:
Discover How to Report Open Capsular Shift
Question: Our surgeon performed an anterior reconstruction of the shoulder with a c... 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 de... Read more
Diagnostic tests:
Dodge Double-Billing Interp Claim Mishaps With This Advice
You may not always be able to report CPT® code, but discover this big benefit. Whe... Read more
Get Ready For Dozens of New Options For Meniscus Tears
You’ll ditch your current 836.xx options and specify the type of meniscus tear. ... Read more
Reader Question:
Avoid Billing Script Refill Alone
Question: Can we bill when the physician is only writing a prescription? We want to... Read more
Reader Question:
A 'Joint Fracture' Doesn't Make Sense
Question: Which diagnosis code should I use for an SI joint fracture? Ohio Subscr... Read more
Reader Question:
Locate Q6 for Locum Tenens
Question: My orthopedic surgery group is using a locum tenens to fill in at the hos... Read more
You Be the Coder:
Factor Patient's Status Into This E/M Scenario
Question: My orthopedist’s notes indicate an expanded problem focused history... Read more
CPT® 2015:
Ultrasound and Imaging Guidance Inclusions Highlight Orthopedic Surgery Changes
Don’t miss the new terminology for cervical disc replacement. The new codes for ... Read more
Unlisted Procedures:
Follow These 4 Steps to Unlisted Procedure Success
Remember payer guidelines to choose accurate comparisons. You may find that CPT® 2... Read more
News You Can Use:
CMS Debuts 4 New Modifiers to Substitute for 59
Medicare will still accept modifier 59, but use the new modifiers instead when applicabl... Read more
Smooth Your Spinal Stenosis Transition by Learning New Dx Sooner Rather than Later
Hint: You’ll have more options in 2015 than 724.xx describes.  Spinal steno... Read more
Reader Question:
Telephone E/M Service Can Roll Into History or MDM
Question: We have a new patient that called his physician to discuss his visit that... Read more
You Be the Coder:
When First Procedure Fails, Do This
Question: Our surgeon performed a total knee replacement, but after the glue hardened... Read more
Optimize Your Lisfranc Op Note With This Advice Before You Code Another Claim
If your Medicare carrier requires modifier 76 instead of 59, here’s what to do. ... Read more
Separate Procedures:
2 Examples Sharpen Your Separate Procedure Claims
CCI is an important tool when you are not sure about a bundle. You shouldn’t ass... Read more
Know the Rules Before You Jump at 59
Although you shouldn’t be afraid to use modifier 59 when the medical necessity and... Read more
Clip-and-Save Bonus:
Pinpoint Your Place-of-Service Coding With This List
This list will direct you to your most common POS code. Choosing the correct place-of-... Read more
News You Can Use:
CMS Solidifies 2015 Date, Clarifies Testing
The agency also offers an alternative claim submission method. Although the latest ICD... Read more
Focus on Laterality for These Sciatica Equivalents
Don’t overlook this Excludes1 Note. Sciatica means the patient presents with com... Read more
Reader Question:
Does a Consult Have to Specify a Name? Find Out
Question: How specific must a non-Medicare consult request be? I know there must be... Read more
Reader Question:
Draw the Line Between Post-Op Brace Fitting and Education
Question: Can my physician bill for a fitting and education of a brace during the p... Read more
Reader Question:
Hone in on This Knee Hematoma CPT® Code
Question: My orthopedist evacuated a hematoma at the prepatellar bursa on the left ... Read more
Reader Question:
Include Volar Plate Repair in 26370
Question: Our orthopedic surgeon repaired a patient’s flexor pollicus longus ... Read more
You Be the Coder:
Navigate This Liner Exchange Scenario
Question: Our surgeon plans to perform an arthroscopy and a liner exchange of a pre... Read more
Refer to These Rotator Cuff Upgrade Strategies to Guarantee Your Claim's Success
Is your payer’s advice lacking? Here’s how to create internal guidelines for... Read more
Watch Out: Adult E/M Criteria May Not Apply to Pediatric Patients
You may be able to substitute notes to justify a higher-level E/M. As summer time roll... Read more
Don't Wrestle With Which Wrist Sprain to Report in 2015
Tip: You’ll need to specify the joint and the side. When a patient presents with... Read more
Reader Question:
Toss 27705 As an Option for Fulkerson Procedure
Question: My orthopedist did an anteromedial tibial tubercle transfer (Fulkerson pr... Read more
Reader Question:
Turn To 64493 for Lumbar Pars Injection
Question: For a patient who is diagnosed with lumbar pars defect, can we report cod... Read more
Reader Question:
Keep An Eye on the Calendar
Question: The CPT® surgery guidelines state that the surgical package includes ... Read more
Reader Question:
Watch Pin Removal Place of Service
Question: One of my surgeons is billing out an in-office pin removal during the pos... Read more
Reader Question:
Assess Risk on a Regular Basis
Question: We are having a bit of a debate in our practice. Some of us think that perform... Read more
You Be the Coder:
Reevaluate This Repair, Debridement, Resection Scenario
Question: According to my orthopedist’s op note, the patient underwent a medi... Read more
Op Note:
Target This Complex Total Knee Replacement Scenario With 3 Focused Steps
Here’s why you need modifier 22 for the necrotic bone graft from the prior fixatio... Read more
Coding Quiz:
Take This True/False Challenge to Safeguard Yourself Against CTS Denials
You won’t find specific guidelines for moving to the next treatment level. When ... Read more
Don't Let Transitioning from 719.4x to M25.5-- Become a Pain
Check out how your joint pain diagnoses will be more detailed in 2015. You may be used... Read more
Reader Question:
Avoid Unlisted CPT® for Quad Repair Code
Question: Our orthopedic surgeon recently performed a quadriceps tendon repair but ... Read more
Reader Question:
Sort Out This ER, Then Assumed Care Scenario
Question: My orthopedist treated a patient who was first seen in the ER for an open... Read more
Reader Question:
Comparison X-Rays May Not Be Payable
Question: We recently saw a patient who injured his leg in a car accident. The surg... Read more
You Be the Coder:
Surrounding Soft Tissue Is Key for Sinus Tarsi Space Injection
Question: I recently received a denial for a cortisone injection to the sinus tarsi... Read more
Don't Miss Picking Up $258 More For Closed Hip Dislocation Treatments Requiring Anesthesia
Here’s how to steer clear of traumatic hip dislocation’s hidden traps. To ... Read more
Demolish Any Possible Denials for Spinal RF Ablation with These Tips
Include add-on codes for each additional level. Reporting the radiofrequency (RF) abla... Read more
CMS Answers ICD-10 Questions -- By Not Answering
Representatives stay mum about the details of the delay. The recent delay of ICD-10 un... Read more
Reader Question:
Get In Perfect Alignment With Hip Injection Procedures
Question: We performed an arthrocentesis (20610) using pre-procedure and intra-proc... Read more
Reader Question:
Kick Off Blanket ABNs
Question: I recently started working at a practice that I think overuses ABNs. Can ... Read more
Reader Question:
Learn if a Nurse Can Request a Consult
Question: I have a provider who documented a consultation note for a patient whom a... Read more
Reader Question:
Not All Team Work Qualifies For Modifier 62
Question: When two or more surgeons work together in a procedure, do they quality a... Read more
Reader Question:
Watch Guidelines for Finger Modifiers
Question: How do I code the procedures when our surgeon corrected two trigger finge... Read more
Reader Question:
Hold Local Medicare to NCDs
Question: Are National Coverage Determinations (NCD) binding on contractors? Mich... Read more
You Be the Coder:
Remove Your Doubts for Coding Joint Injections
Question: Is it correct, according to CPT®, that there are restrictions while r... Read more
News You Can Use:
Congress Votes to Halt Your Pay Cuts and Delay ICD-10 For At Least Another Year
Physician associations still plan to pursue a permanent SGR formula revision.  Th... Read more
Modifier 24:
Bust These 5 Modifier 24 Myths For Picture Perfect Claims
Focus on the surgeon’s documentation, not the appointment book. If you want to e... Read more
Use These 3 Tips to Give Your PLIF Claims Wings
Remember to capitalize on separately reportable bone grafts. When your orthopedist per... Read more
In the Orthopedic Coding Alert, March 2014, the article entitled, “Knees: Confront... Read more
Reader Question:
This is Why You Should Say 'No' to Repeated Reduction Code
Question: Our orthopedist completed a reduction in the office for a dislocation, pl... Read more
Reader Question:
CCI 20.1 Adds a Handful of New Arthroplasty, FBR Edits
Question: I saw that the Correct Coding Initiative (CCI) version 20.1 came out. Was... Read more
Reader Question:
How to Code This New, Recurrent HNP Scenario
Question: Our physician performed surgery due to recurrent HNP at L5-S1 and a new H... Read more
You Be the Coder:
Manage How You Apply Finger Modifiers
Question: How do I code the procedures when our surgeon corrected two trigger finge... Read more
Confront Medication, Diagnoses, and E/M Challenges for Hyaluronic Acid Injections
Here’s what you should do when your orthopedist treats both knees. Physicians ad... Read more
How to Make Your X-Rays During the Global Period Claims Picture Perfect
Find out when to apply modifier 76. Myth:  X-rays that you shoot or interpret dur... Read more
Manage How You Append Modifier 25 for Claim Success
Review the basic rules to increase your effectiveness. Last month you learned three ea... Read more
10 FAQs Smooth Out Your Transition From ICD-9-CM to ICD-10
Let these tips from NGS guide you. Getting ready to submit your orthopedic claims usin... Read more
Reader Question:
Don't Let Your MDM Endanger Your Claim
Question:  A fellow coder told me that for an established patient, I only need two ... Read more
Reader Question:
Determine Open/Closed and Acute/Chronic For This Suprascapularis Code
Question: What is the correct code for suprascapularis tendon repair? Minnesota Subscr... Read more
Reader Question:
Strike Mod 26 When You Own Equipment
Question: The physician used our X-ray equipment in the office to place the needle ... Read more
Reader Question:
For Debridement Level, You Need to Count Regions
Question:  The physician’s notes state, “Bursal side rotator cuff showe... Read more
You Be the Coder:
Try Your Hand at This Arthrotomy Procedure
Question: My orthopedist performed the following procedures: 1. I&D paronychi... Read more
CCI 20.0:
Will You Be Paid for Interprofessional Consults? CCI Says No
Find out if you can use a modifier to separate these edits. Every Jan. 1 brings code c... Read more
Coding Quiz:
3 ICD-10 Questions Gauge Your Orthopedic Coding Preparedness
Tip: Remember to code to the highest level of specificity. Want to know if you’r... Read more
ICD-10 Brings 3 Times More Recurrent Shoulder Dislocation Diagnoses
Don’t miss these Excludes2 notes. Patients suffering from recurrent dislocation ... Read more
Coding Quiz Answers:
Discover Whether You Made the Grade With These Expert-Approved Answers
Hint: These closed/open guidelines are the same — the displaced/nondisplaced guide... Read more
Reader Questions:
Discover How to Code This Elbow Explant
Question: Our orthopedist saw a patient who had a severe infection around her elbow impl... Read more
Reader Questions:
Examine the Extent of Debridement in Arthroscopy
Question: How do we report the arthroscopic excision of a detached anterior labral tear ... Read more
Reader Questions:
How to Receive Full Payment for Pilon Fractures
Question: Our surgeon stabilized a pilon fracture using an external fixator and operated... Read more
Reader Questions:
Be Specific With Repair or Realignment in Finger Tendons
Question: What code do we use for a MCP capsulorrhaphy? The operative note reads: &ldq... Read more
Reader Questions:
Bundling in 29823 and 29824
Question: Our orthopedic surgeon did a debridement of the labrum along with a rotator cu... Read more
Reader Questions:
Define 'Maintenance Therapy'
Question: Our insurers don’t allow us to pay for “maintenance therapy.&rdquo... Read more
You Be the Coder:
No Face-to-Face May Mean No Code
Question: My orthopedist sent a patient with osteomyelitis to the hospital for IV therap... Read more
Distinguish 5 Types of Ankle Fracture Repairs With This Advice
Apply this open/closed concept to avoid 27786-27814 pitfalls. Every dollar counts, and... Read more
Avoid Bending the Rules When It Comes to Collateral Ligament Claims
Here’s why you need to know if the procedure was a repair or a reconstruction. W... Read more
Clip 'n' 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
Master Modifier 25 Following These Expert Tips
Haphazardly using 25 on all claims will lead to payer scrutiny. With payers cracking d... Read more
Underlying Condition Will Be Key to Choosing Pathological Fracture Diagnosis
This common diagnosis supporting vertebroplasty or kyphoplasties will become more inclus... Read more
Reader Question:
Pick Your Prominent Hardware Code
Question: My physician’s note states, “Previous incisions incised.....bluntl... Read more
You Be the Coder:
Synovectomy Including Debridement of Cyclops Lesion
Question: How would I code arthroscopic partial synovectomy including debridement of cyc... Read more