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Orthopedic Coding Alert

2019 Fee Schedule:
CMS Tables E/M Pay Changes for 2019
Medicare puts a twist on ‘blending' proposal … then delays it. The annual CMS Medicar... Read more
Case Study Corner:
Check Coding Smarts With This Cervical Disc Disorder Encounter
Can you make all the right moves to code this clinical scenario? Patients reporting to th... Read more
2019 Fee Schedule:
Telehealth, Virtual Care Gaining More Acceptance
Medicare G codes make reporting possible. The ink is barely dry on the 2019 Medicare Phys... Read more
Reader Question:
Know Fracture, Treatment Type for Optimal Coding
Question: After an office evaluation and management (E/M) service for a patient with an in... Read more
Reader Question:
Use ICD-10 Coding Notes in the Appropriate Context
Question: At the beginning of the J section in the ICD10-CM manual, there is a note to cod... Read more
Reader Question:
Heed the Global Warning in This Playground Accident Encounter
Question: A 7-year-old was playing on the monkey bars at a local park when he fell and par... Read more
You Be the Coder:
Purpose Defines Orthotic Fitting Sessions
Question: During an office visit with an established patient, the provider performs an ort... Read more
CPT® Coding:
Optimize Coding With This Humeral Shaft Fx Advice
Open vs. closed often hinges on fracture type. Patients who suffer humeral shaft fracture... Read more
ICD-10 Coding:
Straighten Out Your Coding for Common Disc Disorders
Myelopathy, radiculopathy knowledge will make Dx choice easier. When it comes to cervical... Read more
CPT® Coding:
Cervical Disc Disorder Tx Could Include Several Options
Surgery, therapy, medication? They're all on the table when treating these patients. Ther... Read more
Reader Question:
Know Multi-Endoscopy Rule to Master Arthroscopy Coding
Question: After a level-three evaluation and management (E/M) office service for an establ... Read more
Reader Question:
If You Code FNAs, Check Out These 2019 Changes
Question: Our providers sometimes must perform fine needle aspirations (FNAs) for patients... Read more
Reader Question:
Make Proper Modifier Decision on E/M-X-Ray Combo
Question: An established patient reports to the orthopedist reporting pain on her right si... Read more
Reader Question:
Reserve LT for Fill-In Physicians Only
Question: Can we code for a nonphysician practitioner's (NPP) service with a locum tenens ... Read more
You Be the Coder:
Can You Crack This Clavicular Fx Scenario?
Question:  An established patient presents with an injury to her left shoulder. She s... Read more
CPT® Coding:
Take This I&D Coding Advice, Avoid Drain on Your Bottom Line
Coding for incision & drainage relies on treatment depth. If your orthopedist has to ... Read more
Learn These Ortho-Specific Coding Conventions for I&D Success
Expert: Don't confuse I&D with irrigation and debridement. Orthopedic coders might no... Read more
ICD-10 Coding:
Keep Your Future Bright by Confirming CTS
Want your CTS treatment claims accepted? Prove you have a CTS Dx first. When you are codi... Read more
Reader Question:
Use These Details to Discern Achilles, Peroneal Tendinitis
Question: What is the difference between Achilles tendinitis and peroneal tendinitis? And ... Read more
Reader Question:
Hang Up on This Modifier
Question:  When telehealth services are provided from our practice office, should our... Read more
Reader Question:
Get More Detail for Knee Arthroplasty Claim
Question: Notes indicate that the orthopedist performed an arthroplasty on a patient's lef... Read more
Reader Question:
Update Appeals Process With These Tips
Question: We were a solo practice for about 15 years, and the founding physician's wife wa... Read more
You Be the Coder:
Critical Care Start Times
Question:  When coding for critical care, is time spent in pre-hospital medical direc... Read more
CPT® Coding:
Follow These Debridement Rules for Maximum Payment
Multiple debridements can mean multiple codes … sometimes. When your orthopedic surgeon... Read more
Hand In Claims With Finger/Toe Modifiers, When Required
If you sleep on these modifiers, it could end up costing you. In general, orthopedic prac... Read more
E/M Coding:
Keep Payers' HPI Elements Straight for Accurate Coding
Duration is an HPI element … except when it isn't. Anyone who has to file a code for an... Read more
Reader Question:
Employ 'Other' Classification for Some Spondylopathies
Question: The orthopedist performs a level-two evaluation and management (E/M) service for... Read more
Reader Question:
NGS Launching NPP-Related 'Patients Over Paperwork' Drive
Question: I have heard a lot about the latest push by Medicare to stress “patients over ... Read more
Reader Question:
Count Negatives for Positive ROS Coding
Question: Can we count a “complete” ROS when the surgeon includes a statement such as ... Read more
You Be the Coder:
Reporting Monteggia Type Fracture Fixes
Question: I have a claim in front of me that is completely bewildering. Notes indicate tha... Read more
News You Can Use:
Proposed PFS Rate, E/M Level Assignment Highlight CMS Release
There's not much of a hike to proposed 2019 fee schedule rate. CMS released its proposal ... Read more
Unlock the Mysteries of MRI Coding With These Tips
Anatomy, guidance questions play a big part in correct coding. Before deciding on a treat... Read more
E/M Coding:
Use 99211 Correctly for E/M Success
Check out these rules for reporting E/M without a physician present. Even the most skille... Read more
Reader Question:
Get on the Level for Correct Debridement Add-On
Question: During the course of treating a patient who was in an automobile accident, our o... Read more
Reader Question:
Keep Pathological, Recurrent Separate with These Tips
Question: For ICD-10-CM coding purposes, what is the difference between unclassified patho... Read more
You Be the Coder:
Dx Coding for Ankle, Fibula Fractures
Question: Our orthopedist performed a three-view ankle x-ray for a left, displaced lateral... Read more
ICD-10-CM Update:
Code Set for 2019 Includes Expanded Myalgia Options
Remember, ICD-10-CM 2019 begins on October 1, 2018. The final list of ICD-10-CM codes for... Read more
Walk Correct Coding Path With Clavicular Fractures
Remember difference between open and closed treatments. Patients presenting to the orthop... Read more
E/M Coding:
Check Provider Before Choosing Prolonged Services Codes
Remember to choose different codes for clinical staff. When your orthopedic practice sees... Read more
Reader Question:
Make Sure E/M's Unrelated for Modifier 24
Question: A patient has a diagnosis of bilateral carpal tunnel syndrome, right worse than ... Read more
Reader Question:
Ace CCI Edit with Exclusive, Unlikely Knowledge
Question: The Correct Coding Initiatives (CCI) is an enigma to me; I have a lot of trouble... Read more
Reader Question:
Watch Out for Different Lateral Release Codes
Question: Operative notes indicate that after a level-four evaluation and management (E/M)... Read more
Reader Question:
Employ Education to Cut PHI Breaches
Question: What can I do to make sure our practice stays current on best practices to avoid... Read more
You Be the Coder:
Ankle Pain Diagnosis Coding
Question: A patient reported to our practice complaining of pain in the right ankle region... Read more
CPT® Coding:
Dodge Denial Bullet with Arthrocentesis/Aspiration/Injection Advice
Here's why anatomy is so important to correctly coding these claims. When you're coding f... Read more
Scrubbing the Claim:
Don't Miss Multi-Code Chances on Arthrocentesis/Aspiration/Injection
Pre-procedure E/M could increase your code count. When your orthopedist performs arthroce... Read more
CPT® Coding:
Know Your Levels, then Code these Facet Joint Injections
Remember: Cervical/thoracic, lumbar/sacral shots might be multi-code encounters. Patients... Read more
Using 24 Gets Easier with this FAQ
Recoup money for E/Ms unrelated to postop with this modifier. How to use modifier 24 is o... Read more
Reader Question:
Get More Detail for Discitis Dx
Question: During the course of a level-two evaluation and management (E/M) service for a n... Read more
Reader Question:
History Knowledge Vital for E/M Chart Coding
Question: When coding a chart for an evaluation and management (E/M) service, how do we kn... Read more
You Be the Coder:
Choosing Fracture Fix Code
Question: How should I code for closed treatment of a humeral shaft fracture? My orthopedi... Read more
Stay on Your Toes with this Achilles Repair Coding Advice
Here's why a graft is a major detail in any Achilles op report. When a patient suffers a ... Read more
Keep Compliance Concerns at Bay with Incident-to Smarts
Medicare benefit can maximize your payouts. Orthopedic practices that provide services in... Read more
Fill in Whole Dx Picture with Chapter 20 Codes
Reporting external causes pinpoints condition, can improve patient outcomes. While it's t... Read more
Reader Question:
Guidance Type Matters on Arthrocentesis Claims
Question: Our orthopedist performed an arthrocentesis injection on a patient's left ring f... Read more
Reader Question:
Save Room for 7th Character on Crush Injuries
Question: The orthopedist performed a level-three evaluation and management (E/M) service ... Read more
Reader Question:
UHC Now Demands this Modifier for Some NPP Claims
Question: We've been having some problems with payment for our nonphysician practitioners ... Read more
Reader Question:
New CMS Program Aims to Simplify EHR Regs
Question: What do I need to know about the MyHealthEData initiative recently announced by ... Read more
You Be the Coder:
Master Subluxation Subtleties for Optimal Dx Coding
Question: Our provider had her first office visit with a patient who has a recurrent patel... Read more
Shoulder Surgery:
Keep Your Options Open on Shoulder Arthroscopies
Note surgical technique to avoid coding confusion. Patients presenting to the orthopedist... Read more
ABNs Are Handy for Medicare ... and Some Private Payers
When there's an issue with payment, ABN can be your friend. Most practices providing serv... Read more
ICD-10 Coding:
Look to these Rib Fracture Dx Codes for Open/Closed Fixes
Remember the S22.--- codes for breaks. Orthopedic practices that treat patients for rib f... Read more
Reader Question:
Check Out this Change to Student E/M Documentation Rules
Question: Our physicians often complain about having to re-document the elements of evalua... Read more
Reader Question:
Scrub Notes to Unlock this Myositis Mystery
Question: Our orthopedist documented that a patient was suffering from pain, swelling, ten... Read more
Reader Question:
Use these 2 E/M Modifiers Together ... Sometimes
Question: Can you ever report modifiers 24 and 25 on the same claim? Ohio Subscriber Ans... Read more
Reader Question:
Choose Flexor Tendon Fix Code Carefully
Question: What code should I use for extensor tenosynovectomy of the hand/fingers? Notes i... Read more
Reader Question:
Narrow Hamstring Tenotomy Choices to this Code Trio
Question: Operative notes indicate that my orthopedist performed a knee-to-hip hamstring t... Read more
You Be the Coder:
Dig for Arthrodesis Details
Question: Operative notes indicate that the provider performed tarsometatarsal arthrodesis... Read more
Knee Surgery:
Ace ACL Claims with these Tips
Look for evidence of arthroscopic aid on 29888 claims. For professional athletes, weekend... Read more
Knee Surgery:
Know Your Anatomy Front and Back for Cruciate Ligament Repairs
ACL, PCL repairs are different sides of the same coin. When most people think of knee inj... Read more
E/M Coding:
Observe Different Rules for Medicare, Private Payer Consults
You can't use CPT® codes for Medicare consults. When your orthopedist is called for a co... Read more
Experts: G Modifiers Gaining Steam Toward Mainstream
GA is now required by many Medicare payers to indicate ABN. When your provider performs a... Read more
Reader Question:
Determine Site for Definitive Debridement Documentation
Question: One of our patients was recently involved in a skateboard accident, which result... Read more
Reader Question:
1 Code Covers Aspiration, Injection of Same Joint
Question: How do I code a scenario in which the provider performs a knee aspiration and th... Read more
You Be the Coder:
Go to 7th Spot for Fracture Dx
Question: Noted indicate that the orthopedist treated a patient with a closed oblique frac... Read more
Heed Hammertoe Edit on Capsulotomies
New edit sports modifier indicator of '1.' To kick off 2018, let's take a look at a late-... Read more
Know Your Open/Closed Rib Fracture Fix Codes
Incision key in coding these scenarios correctly. When patients report to the orthopedist... Read more
E/M Coding:
Use Targeted ROS Advice, Zero in on Correct Code
This FAQ sheds light on common system review problems. A key component to most evaluation... Read more
Reader Question:
Remember 25 for your E/M/Injection Encounters
Question: Encounter notes indicate that the provider performed a level-four evaluation and... Read more
Reader Question:
Prove Previous Tx Attempts on CT Appeal
Question: Three months ago, our provider saw a patient complaining of wrist pain, a burnin... Read more
Reader Question:
NPI Leads the Way to Part A/B Decision
Question: The hospital admitted a Medicare patient three days ago, and she underwent emerg... Read more
Reader Question:
Lean on this List for PFSH Conundrums
Question: Can you give me an example of pertinent past, family, and social history (PFSH) ... Read more
You Be the Coder:
Go Deep into Details for Specific Limb Length Dx
Question: Notes indicate that the provider performed a level-three new patient evaluation ... Read more
Fracture Care:
Freshen Up Your Fracture Terminology Acumen with this FAQ
Remember, open and closed fracture knowledge essential. Orthopedic coders will be dealing... Read more
Injection Coding:
Stay Sharp to Ace Trigger Point Claims
Providers can perform TPIs for various ailments. Patients in pain will often require trig... Read more
Adhere to Locum Tenens Rules for 'Substitutes'
Replacement physicians often sub for providers on leave. Just about every orthopedic prac... Read more
Reader Question:
Don't Fall for this Prolonged Services Myth
Question: Can you report prolonged services with any level of evaluation and management (E... Read more
Reader Question:
Use Long-Arm Splint Code for Elbow Injury
Question: A young athlete came into our office with a sprained elbow he received while pla... Read more
Reader Question:
Check for E/M on this I&D Encounter
Question: One of our established patients with diabetes recently competed in a marathon. S... Read more
You Be the Coder:
X-Ray Coding Rules
Question: For an x-ray that included three shoulder views, our coder reported 73020 (one v... Read more