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Orthopedic Coding Alert

Score points with accurate ACL coding Accurate ACL Coding
Start with 29888, but check global package and add-ons for your most complete claim. With... Read more
Check Global Package and Graft Terminology Before Finalizing Your ACL Claim
Some extra services mean more codes -- but many don't. Don't be too hasty when repor... Read more
Keep 2 Tips in Mind to End Cast Coding Mix-Ups
Watch 'procedure,' Q codes to collect all your pay, every time. Letting extra codes for c... Read more
Clinch Decompression, Fusion Procedures With These Tips
If you always turn to 62, 80, or 81, our experts' answer might surprise you. You can save... Read more
READER QUESTIONS:
20550 or 20551 for Elbow Epicondylitis Injection
Question: What is the best code for an injection to treat elbow epicondylitis? Missouri S... Read more
READER QUESTIONS:
Say 'No' to Repeated Reduction Code
Question: Our orthopedist completed a reduction in the office for a dislocation, placed a... Read more
READER QUESTIONS:
Brace Fitting Go-Ahead Depends on Intent
Question: Can we bill for a brace fitting prior to surgery? If so, what codes do we repor... Read more
READER QUESTIONS:
Malunion Repair Includes Allograft
Question: Operative findings included a healed fracture malunion with shortening of dista... Read more
READER QUESTIONS:
Watch Guidelines for Finger Modifiers
Question: How do I code the procedures when our surgeon corrected two trigger fingers dur... Read more
READER QUESTIONS:
Verify All Work Before Counting Synovectomy Compartments
Question: The orthopedist completed a three-compartment major synovectomy, medial and lat... Read more
You Be the Coder:
Submit Multiple Codes for New, Recurrent HNP
Question: Our physician performed surgery due to recurrent HNP at L5-S1 and a new HNP at ... Read more
Op Note Coding:
3 Simple Steps Take Control of This Complex Total Knee Replacement Scenario
Modifier 22 addresses the necrotic bone graft from the prior fixation. If you can tackle ... Read more
Bust 5 Myths to Safeguard Yourself Against CTS Denials
You won't find specific guidelines for moving to the next treatment level. When a patient... Read more
Traverse Open, Closed Terminology and Arrive at Fracture Dx
If your physician doesn't specify open or closed, side on this type of fracture. Can you ... Read more
READER QUESTIONS:
Decubitus Ulcer Care? Look to 15920 Series
Question: Our surgeon saw a patient status post hip replacement and he debrided two sites... Read more
READER QUESTIONS:
Ante Up Your Ortho Diagnosis Possibilities
Question: Our surgeon submitted the following operative note, but we can't determine whic... Read more
READER QUESTIONS:
Separate Supply Code From Global
Question: My orthopedist saw a patient still under her global period for open reduction, ... Read more
READER QUESTIONS:
Factor Patient's Status Into This E/M Scenario
Question: My orthopedist's notes indicate an expanded problem focused history, a problem-... Read more
READER QUESTIONS:
Sinus Tarsi Space Differs From Tissue
Question: My practice received a denial for a cortisone injection to the sinus tarsi. We ... Read more
READER QUESTIONS:
Use Modifier for Separate Plates
Question: Our orthopedic surgeon placed two different cervical plates at different spinal... Read more
You Be the Coder:
Synovectomy Versus Debridement
Question: My orthopedist performs an arthroscopy on a patient's shoulder. What is the dif... Read more
Expert Strategies Help You Manage Your Rotator Cuff Upgrades With Confidence
Is your payer's advice lacking? Here's how to create internal guidelines for chronic/acut... Read more
CCI 15.2 Update:
New Edits Tweak Discography, Fluoroscopy Code Usage
Say goodbye to modifier 59 when reporting 9 ortho coding pairs. Although orthopedics esca... Read more
4 Tips Position Your 'Multiple Scope' Codes Perfectly
Here's what you should do when there's no base procedure. If your physician pe... Read more
Learn Why Acute Versus Chronic Matters
The acute versus chronic decision is important for many reasons. For instance, some state ... Read more
READER QUESTIONS :
Count Your Nerves to Determine Units
Question: What should I count for nerves? If my orthopedist did a median transcarpal stud... Read more
READER QUESTIONS:
Strike Out 27705 for Fulkerson
Question: My orthopedist did an anteromedial tibial tubercle transfer (Fulkerson procedur... Read more
READER QUESTIONS:
Keep Hemilaminectomy Separate From Fusion
Question: Our orthopedic surgeon turned in a note that says, "Performed a bilateral hemil... Read more
You Be the Coder:
Repair, Debridement, Resection Scenario
Question: According to my orthopedist's op note, the patient underwent a medial meniscal ... Read more
Op Note Coding Corner:
Submit Your Hand Surgery Claims to Payers With Confidence Using This Strategy
Don't know what services a CPT code includes? You could be making bundling errors --... Read more
Clip 'n' Save:
Handle Your Hand, Wrist Fracture Diagnoses With Care by Pinpointing Anatomic Site
Here's how to differentiate the tiquetrum from the trapezium. Orthopedic surgeons dealing... Read more
3 Questions Clear Up Your Modifier 24, 25, 57 Confusion
Applying the correct E/M modifier can boost your bottom line by $100. To avoid denials fo... Read more
Modifier Cheat Sheet:
Banish Your E/M Modifier Phobias Forever
You'll never wonder which modifier applies to minor vs. major procedures. If you're often... Read more
READER QUESTIONS:
Dodge G0289, Modifier 22 Mistakes
Question: Our orthopedist did a right knee arthroscopy with extensive tricompartmental sy... Read more
READER QUESTIONS:
Find Your TFCC Code Here
Question: What ICD-9 code should we use for TFCC  (triangular fibrocartilage complex... Read more
READER QUESTIONS:
Sort Out This ER, Then Assumed Care Scenario
Question: My orthopedist treated a patient who was first seen in the ER for an open fract... Read more
READER QUESTIONS:
Carrier Can Secure How You Use S-Codes
Question: We have been billing out 27299 for total hip resurfacing but then Regence reque... Read more
READER QUESTIONS:
Hold Local Medicare to NCDs
Question: Are National Coverage Determinations (NCD) binding on contractors? Michigan Sub... Read more
READER QUESTIONS:
Equate 'Weber B' With Lateral Malleolar Fx
Question: Which CPT and ICD-9 codes should we report when the surgeon dictates a Weber B ... Read more
You Be the Coder :
Untangle Hardware Removal, Reinsertion Coding
Question: My orthopedist removed posterior hardware at L5-S1 and then decided to do a fus... Read more
On the Cutting Edge:
Pull the Plug on PRP Denials by Limiting When You Pick 86999 for PRP Injections
Dont miss reporting blood platelets placement in this situation. If... Read more
News You Can Use:
Commit to New Radius, Ulna Torus Fracture Codes by Oct. 1
No longer will you look to 832.0 for nursemaids elbow. Does your or... Read more
Protect Your Epidural/Spinal Injection Pay With ABNs
Heres when to append modifiers GA, GY, and GZ. Services a patients insurer doesnt cove... Read more
READER QUESTIONS :
Solve Second Surgery Coding
Question: One of our patients underwent a bilateral lumbar laminectomy, decomp... Read more
READER QUESTIONS :
For Comparison X-Ray, Use This Diagnosis
Question: A patient comes in with shoulder pain and possible separation. The o... Read more
READER QUESTIONS :
Don't Assume Open Fractures Mean Open Care
Question: Our orthopedic surgeon documented fracture care for an open scapula ... Read more
READER QUESTIONS :
Put Your Finger on Proximal Row Bones
Question: Our surgeon performed a proximal row carpectomy (PRC) and circled co... Read more
READER QUESTIONS :
Factor In Range of Service in Obese Patient Case
Question: Recently, our surgeon performed spinal fusion (22630) on an extremel... Read more
READER QUESTIONS :
Don't Let Coding Lesion Excisions Be Your Achilles Heel
Question: Our surgeon documented an excision for thickening of the Achilles te... Read more
You Be the Coder :
Medial Meniscectomy, Chrondoplasty
Question: My orthopedist documented the following: I introduced a probe throug... Read more
Case Study Part 1:
Get the Most Pay on This Multi-Trauma Scenario Using Top Down Approach
Heres why youll apply modifier 51 but forgo using modifier 59. On a multi... Read more
Case Study, Part 2:
Master Linking Numerous ICD-9 Codes in Multiple Procedure Cases
Avoid these ICD-9 codes when associated with compartment syndrome. Reread... Read more
Bust 6 Myths to Complete Your Workers' Comp Claims
E codes can get your claim paid faster. Although you have no nation... Read more
Get Hip to Specific Anatomy, Terminology,and Coding
These key terms make coding for hip procedures easier and more accurate. ... Read more
Diagnosis Provides Clues to Correct Coding
Keep these 5 items in mind. Per ICD-9-CM, diagnosis codes for fract... Read more
Ace ASC Coding With These Global Period, Modifier Tips
3 ways your physician claim better look different than a center claim. ... Read more
Expand ASC Allowed Items by 2
Find out what drugs you can bill. Since ASC payments and covered proc... Read more
READER QUESTIONS:
Apply Modifier 22 for ACL Revision
Question: My orthopedist did an ACL repair on a patient several years ago. The... Read more
READER QUESTIONS:
Uncover This Arthroscopy, Meniscectomy Solution
Question: My orthopedist performed an unusual surgery of an arthroscopy and pa... Read more
READER QUESTIONS:
Solve This Cast Supply Code Units Question
Question: Should we use supply code Q4010 as one unit, or can we report multip... Read more
READER QUESTIONS:
Find Your Triceps Repair Code Here
Question: How should I code a triceps repair? Should I use the biceps code (24... Read more
READER QUESTIONS:
Master Multiple Units of 20680
Question: My orthopedic surgeon performed a tibia hardware removal and then a ... Read more
You Be the Coder:
Arthroscopic Biceps Tenotomy
Question: My orthopedist performed an arthroscopic biceps tenotomy and tenodesis. I kn... Read more
Shoulder Study:
Look Before and After Rotator Cuff Repair or Risk Missing Arthroscopies
Acute or chronic? A $60 difference is at stake. If youre not pinpoi... Read more
Did Your Ortho Do a Consult or Referral? You Be the Judge
Collect that extra $50 by applying the 5 Rs. Beware: The feds are s... Read more
Complete Your ICD-9 Coding Picture with These Tips
Code the condition your ortho treats first, followed by co-morbidity. ... Read more
CCI 15.1 Update:
Get the Inside Scoop on How to Simplify 304,000 New Edits
Heres why you shouldnt panic. If youre feeling cross-eyed by the Co... Read more
Crack the Fracture Care Coding Dilemma
6 steps capture exclusions to get you the right code combo. Guest c... Read more
Get More From Your Op Note With Anatomy 411
Define fracture care with ease. Fractures are defined as a disrupti... Read more
READER QUESTIONS:
Orthopedic Surgeons Can Report ED Codes
Question: An emergency department physician asked our surgeon to see a Medicar... Read more
READER QUESTIONS:
Base Total RVU Calculations on 4 Details
Question: How do I determine which RVUs to use in the Medicare fee schedule fo... Read more
READER QUESTIONS:
Clarify Your Diagnosis for Cast Complication
Question: One of our doctors performed a closed reduction on a patients left w... Read more
READER QUESTIONS:
Get The Most Out of This E-Scribe Bonus
Question: I heard that physicians may receive bonuses for e-prescribing. What ... Read more
You Be the Coder :
Go In-Depth With Rigid Mallet Toe Treatment
Question: A patient came into the office with a rigid mallet toe. How will my ... Read more
Dodge Double-Billing Interp Claim Mishaps With This Advice
You may not always be able to report CPT code, but discover this big benefit. When you... Read more
3 Scenarios Not Just Correct, Perfect Your Ortho ICD-9 Skills
Tip: Let the surgeon determine whether the condition is acute versus chronic. If you choo... Read more
Focus on Ankles:
Take the Guesswork Out of Coding 5 Types of Ankle Fracture Repair Codes
Coding additional procedures can boost your bottom line by $500. Mistaking bimalleolar ... Read more
Reader Questions:
Make the Levels Versus Interspaces Distinction
Question: If the surgeon fuses vertebrae L1 through L3, should I report 22612, 22614; or... Read more
Reader Questions:
Evaluate This CPT Errata and Update Your Manual
Question: The inside cover jacket of my CPT manual says that the definition for modifier... Read more
Reader Questions:
Appeal This BCBS Misconception
Question: I am having trouble with Blue Cross Blue Shield (BCBS) with my medial meniscecto... Read more
You Be the Coder:
Get Meniscectomies, Chondroplasties Straight
Question: What percentage of the meniscus must the surgeon remove before we should bill th... Read more
CCI 15.0 Update:
Consider Nerve Blocks, Injections Inherent to Most New Ortho Codes -- Or Face Denials
Watch out: Not all these new edits allow you to unbundle them with a modifier. Although... Read more
Toss Modifier 21 Out and Go to 99354-99359 Instead
See why 30 minutes more than usual is the magic requirement. If your orthopedist spends... Read more
Check Your Payers' 27215-27218 Policies
Rejoice: Pelvic fracture codes spared from CCI 15.0's wrath. Although CPT 2009 changed ... Read more
News You Can Use:
Wrong Spinal Level Can Mean No Reimbursement Whatsoever
Here's what to do if wrong location is due to extra vertebrae. If your orthopedic surge... Read more
Fix Facet Joint Injection Coding in Wake of Startling OIG Report
Agency combed everything from injections to consulting agreements. The Office of the In... Read more
Ring in Better Rewards in '09 With These 3 Don't-Miss Tips-#1:
Save Hundreds With These A/R Best Practices
Tip: Assign each biller a list of payers to contact every month. Effective accounts rec... Read more
#2:
Keep in Mind That Medicare Lowers CF to $36.0666 for 2009
You won't feel as big a crunch, thanks to neutrality adjustment. CMS released the Medic... Read more
#3:
Let 2 Questions Guide You on Deductible Collection
Save time, effort by learning the downsides of up-front collection. Collecting deductib... Read more
Reader Questions :
Leg Amputations Mean 27880
Question: How do leg amputation codes differ from each other? Minnesota Subscriber Ans... Read more
Reader Questions:
Discover When You Should Apply Modifier 99
Question: I have been reporting the following code sequence: - 73562-26 - 73562-99 (in... Read more
Reader Questions:
Prove Separate Service Before Billing E/M in Global
Question: Our payer is denying a claim involving an E/M and a fine needle aspiration (FN... Read more
Reader Questions:
Look to This Shoulder Code for QSS
Question: What is Quadrilateral Space Syndrome, and what ICD-9 code should I use? Georg... Read more
You Be the Coder:
Consults In-Group = Established Patients?
Question: Our orthopedists may refer to one another based on a provider's subspecialty, ... Read more
Coding from the Op Note:
Get a Handle On Hand Surgery Claims By Fixating Finger Modifiers Onto CPT Codes
You could be missing out on reimbursement if you don't thoroughly read the op note. ... Read more
Untangle Unlisted Procedure Coding Mysteries
Tip: Including an explanation in the op note will streamline your claim. When your orth... Read more
CMS Halts IDET, Other TIPs Payment
Here's what to do if your MD performs these services for Medicare patients. If you-ve g... Read more
Delve into Shoulder Anatomy and Weigh these 3 Coding Options for Reverse-Style Replacements
The typically used code for reverse shoulder arthroplasties may not earn you as much as ... Read more
Reader Questions:
Decipher Private-Payer Mystery Edits
Question: I follow Correct Coding Initiative (CCI) edits, but some insurers don't follow... Read more
Reader Questions:
Applying Mod 78? Don't Expect Full Reimbursement
Question: I-ve noticed that when we report procedures with modifier 78, the payer will r... Read more
Reader Questions:
Classify AC Joint as Intermediate
Question: If our surgeon injects a patient's AC joint, should we report 20610? We consid... Read more
Reader Questions:
Rely On E/M Code for Suture Removal
Question: A patient went out of state for surgery (a 90-day global procedure) and came b... Read more
Reader Questions:
Insurers May Balk at Paying Multiple Units of 77002
Question: When we perform multiple injections at the same time, can we report 77002 more... Read more
You Be the Coder:
CPT Notes Can Provide You With Imaging Answers
Question: My physician performed ultrasound guidance for aspiration. What does this invo... Read more
CPT Update:
Inclusion of 'Unilateral' to Pelvic Fx Repair Codes Could Add $685 to Your Bottom Line
CMS doesn't agree with this revision, so here's what you will have to report instead. I... Read more
CPT Update:
Streamline Slew of New Ortho Codes With These 5 Groupings
CMS prices 2 new codes as over $1000 -- Will you recoup that pay? You can stop fee... Read more
CPT Update:
Take Note of Decompression, Tendon Transfer Revisions
Amazing: CPT throws 2 regular CPT codes back into Cat. III status. To obtain picture-... Read more
Guest Columnist:
Quita W. Edwards, CCS-P, CPC-Ortho, CPC-I
Watch out: Multiple providers sometimes necessitate modifiers. You can sail through cod... Read more
Look for These Key Words When Assigning Post-Op Modifiers
Hint: Repeated debridements are often staged' Whether your group is left footing the bi... Read more
Speed OTN Pay With EM Designation
Orthopedic emergencies require immediate intervention normally within six hours. Beyond ... Read more
10 Steps to Submitting Error-Free Ortho Claims
You-ll capture every allowed procedure with these tips. Injuries won't be able to lurk ... Read more
Reader Questions:
Catch This Compartment Syndrome Difference
Question: What is the difference between traumatic and non-traumatic compartment syndrom... Read more
Reader Questions:
Complex ACL Reconstructions Need This Modifier
Question: Another orthopedic surgeon performed a faulty ACL reconstruction on a patient,... Read more
Reader Questions:
Get the Latest About the ICD-10 Announcement
Question: I heard the Dept. of Health and Human Services (HHS) announced when we-ll have... Read more
Reader Questions:
Verify Details for Synvisc Coding
Question: What diagnosis should I submit to support Synvisc administration? Rhode Islan... Read more
You Be the Coder:
Re-Fracture During Post-Op Period
Question: Our physician saw and treated a patient for a scaphoid fracture. The patient, ... Read more
News You Can Use:
CCI 14.3 Changes How You Report Arthroplasty Plus Prosthesis Codes
You also have more moderate sedation edits to apply. Version 14.3 of the Correct Coding I... Read more
Kick Knee-Related Injection Rejections Out of the
Code 20610 might always need a modifier for Medicare pay. If denials for trigger point an... Read more
OIG Spotlight:
Here's How to Avoid Facet Joint Injection Problems
Hint: Bilateral injection errors accounted for scores of issues. According to a Sept. 17 ... Read more
Reader Question:
Don't Miss the 'Or' in Modifier 58 Description
Question: To append modifier 58, does the procedure have to meet all three of the criteria... Read more
Reader Question:
Choose 27193 for Pelvic Avulsion
Question: Which code should I use for fracture care of anterior iliac spine avulsion with ... Read more
Reader Question:
Trust 842.12 for Gamekeeper's Thumb
Question: What codes should I report for a patient who received strapping for skier's thum... Read more
Reader Question:
Keep Removal and Reinsertion off Same Claim
Question: If the surgeon removes instrumentation, performs a revision spine procedure, and... Read more
Reader Question:
No Patient There? Don't Expect Payment
Question: Should we bill an office visit (99211-99215) for a consult with a family member ... Read more
Reader Questions:
Get to the Root of 'LNR'
Question: What codes should I use for lumbar paravertebral facet nerve injection and a lum... Read more
Reader Question:
Count Reviewing Records as Part of E/M
Question: My physician wants to bill for the time she spends reviewing medical records fro... Read more
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