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Orthopedic Coding Alert - 2014; Volume 17, Number 12
Heel:
Build a Firm Foundation for Plantar Fasciitis Coding
Keep tabs on details to help justify more extensive treatments later. Plantar fasciiti...
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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 ...
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ICD-10:
Expand Your 355.6 Diagnosis Into Three Options in 2015
Key: Laterality becomes important. Lesion of plantar nerve means that the patien...
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Compliance:
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...
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Reader Question:
Get the Scoop on Saucerization
Question: Our surgeon performed a saucerization of the lateral discoid meniscus, but ...
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Reader Question:
Your Orthopedic Surgeons Can Report ED Codes
Question: An emergency department physician asked our surgeon to see a Medicare pat...
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You Be the Coder:
Document An Incomplete ROS
Question: When we have an established patient that comes into our office that needs...
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Orthopedic Coding Alert - 2014; Volume 17, Number 11
Wrist:
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...
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Modifiers:
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...
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ICD-10:
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...
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ASCs:
3 Tips Analyze Your ASC Coding Rules
Here’s how to properly use modifier SG. Suppose you bill Medicare when your surg...
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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 ...
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Reader Question:
Cross Modifier 50 Out for Trigger Point Injections
Question: How should I report bilateral trigger point injections in three locations...
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You Be the Coder:
Discover How to Report Open Capsular Shift
Question: Our surgeon performed an anterior reconstruction of the shoulder with a c...
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Orthopedic Coding Alert - 2014; Volume 17, Number 10
Shoulders:
Don't Let Tissue Scaffolding Procedures Complicate Your RCR Claims
Scrutinize the op report to determine whether the physician used a tissue scaffolding de...
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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...
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ICD-10:
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. ...
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Reader Question:
Avoid Billing Script Refill Alone
Question: Can we bill when the physician is only writing a prescription? We want to...
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Reader Question:
A 'Joint Fracture' Doesn't Make Sense
Question: Which diagnosis code should I use for an SI joint fracture? Ohio Subscr...
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Reader Question:
Locate Q6 for Locum Tenens
Question: My orthopedic surgery group is using a locum tenens to fill in at the hos...
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You Be the Coder:
Factor Patient's Status Into This E/M Scenario
Question: My orthopedist’s notes indicate an expanded problem focused history...
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Orthopedic Coding Alert - 2014; Volume 17, Number 9
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 ...
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Unlisted Procedures:
Follow These 4 Steps to Unlisted Procedure Success
Remember payer guidelines to choose accurate comparisons. You may find that CPT® 2...
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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...
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ICD-10:
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...
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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...
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You Be the Coder:
When First Procedure Fails, Do This
Question: Our surgeon performed a total knee replacement, but after the glue hardened...
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Orthopedic Coding Alert - 2014; Volume 17, Number 8
Foot:
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. ...
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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...
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Know the Rules Before You Jump at 59
Although you shouldn’t be afraid to use modifier 59 when the medical necessity and...
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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-...
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News You Can Use:
CMS Solidifies 2015 Date, Clarifies Testing
The agency also offers an alternative claim submission method. Although the latest ICD...
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ICD-10:
Focus on Laterality for These Sciatica Equivalents
Don’t overlook this Excludes1 Note. Sciatica means the patient presents with com...
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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...
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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...
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Reader Question:
Hone in on This Knee Hematoma CPT® Code
Question: My orthopedist evacuated a hematoma at the prepatellar bursa on the left ...
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Reader Question:
Include Volar Plate Repair in 26370
Question: Our orthopedic surgeon repaired a patient’s flexor pollicus longus ...
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You Be the Coder:
Navigate This Liner Exchange Scenario
Question: Our surgeon plans to perform an arthroscopy and a liner exchange of a pre...
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Orthopedic Coding Alert - 2014; Volume 17, Number 7
Shoulder:
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...
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E/M:
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...
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ICD-10:
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...
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Reader Question:
Toss 27705 As an Option for Fulkerson Procedure
Question: My orthopedist did an anteromedial tibial tubercle transfer (Fulkerson pr...
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Reader Question:
Turn To 64493 for Lumbar Pars Injection
Question: For a patient who is diagnosed with lumbar pars defect, can we report cod...
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Reader Question:
Keep An Eye on the Calendar
Question: The CPT® surgery guidelines state that the surgical package includes ...
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Reader Question:
Watch Pin Removal Place of Service
Question: One of my surgeons is billing out an in-office pin removal during the pos...
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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...
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You Be the Coder:
Reevaluate This Repair, Debridement, Resection Scenario
Question: According to my orthopedist’s op note, the patient underwent a medi...
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Orthopedic Coding Alert - 2014; Volume 17, Number 6
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...
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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 ...
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ICD-10:
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...
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Reader Question:
Avoid Unlisted CPT® for Quad Repair Code
Question: Our orthopedic surgeon recently performed a quadriceps tendon repair but ...
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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...
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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...
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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...
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Orthopedic Coding Alert - 2014; Volume 17, Number 5
Hips:
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 ...
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Spine:
Demolish Any Possible Denials for Spinal RF Ablation with These Tips
Include add-on codes for each additional level. Reporting the radiofrequency (RF) abla...
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ICD-10:
CMS Answers ICD-10 Questions -- By Not Answering
Representatives stay mum about the details of the delay. The recent delay of ICD-10 un...
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Reader Question:
Get In Perfect Alignment With Hip Injection Procedures
Question: We performed an arthrocentesis (20610) using pre-procedure and intra-proc...
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Reader Question:
Kick Off Blanket ABNs
Question: I recently started working at a practice that I think overuses ABNs. Can ...
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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...
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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...
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Reader Question:
Watch Guidelines for Finger Modifiers
Question: How do I code the procedures when our surgeon corrected two trigger finge...
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Reader Question:
Hold Local Medicare to NCDs
Question: Are National Coverage Determinations (NCD) binding on contractors? Mich...
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You Be the Coder:
Remove Your Doubts for Coding Joint Injections
Question: Is it correct, according to CPT®, that there are restrictions while r...
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Orthopedic Coding Alert - 2014; Volume 17, Number 4
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...
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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...
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Spine:
Use These 3 Tips to Give Your PLIF Claims Wings
Remember to capitalize on separately reportable bone grafts. When your orthopedist per...
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CORRECTION
In the Orthopedic Coding Alert, March 2014, the article entitled, “Knees: Confront...
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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...
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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...
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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...
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You Be the Coder:
Manage How You Apply Finger Modifiers
Question: How do I code the procedures when our surgeon corrected two trigger finge...
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Orthopedic Coding Alert - 2014; Volume 17, Number 3
Knees:
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...
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X-Rays:
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...
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Modifiers:
Manage How You Append Modifier 25 for Claim Success
Review the basic rules to increase your effectiveness. Last month you learned three ea...
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ICD-10:
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...
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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 ...
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Reader Question:
Determine Open/Closed and Acute/Chronic For This Suprascapularis Code
Question: What is the correct code for suprascapularis tendon repair? Minnesota Subscr...
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Reader Question:
Strike Mod 26 When You Own Equipment
Question: The physician used our X-ray equipment in the office to place the needle ...
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Reader Question:
For Debridement Level, You Need to Count Regions
Question: The physician’s notes state, “Bursal side rotator cuff showe...
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You Be the Coder:
Try Your Hand at This Arthrotomy Procedure
Question: My orthopedist performed the following procedures: 1. I&D paronychi...
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Orthopedic Coding Alert - 2014; Volume 17, Number 2
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...
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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...
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ICD-10:
ICD-10 Brings 3 Times More Recurrent Shoulder Dislocation Diagnoses
Don’t miss these Excludes2 notes. Patients suffering from recurrent dislocation ...
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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...
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Reader Questions:
Discover How to Code This Elbow Explant
Question: Our orthopedist saw a patient who had a severe infection around her elbow impl...
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Reader Questions:
Examine the Extent of Debridement in Arthroscopy
Question: How do we report the arthroscopic excision of a detached anterior labral tear ...
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Reader Questions:
How to Receive Full Payment for Pilon Fractures
Question: Our surgeon stabilized a pilon fracture using an external fixator and operated...
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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...
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Reader Questions:
Bundling in 29823 and 29824
Question: Our orthopedic surgeon did a debridement of the labrum along with a rotator cu...
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Reader Questions:
Define 'Maintenance Therapy'
Question: Our insurers don’t allow us to pay for “maintenance therapy.&rdquo...
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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...
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Orthopedic Coding Alert - 2014; Volume 17, Number 1
Ankles:
Distinguish 5 Types of Ankle Fracture Repairs With This Advice
Apply this open/closed concept to avoid 27786-27814 pitfalls. Every dollar counts, and...
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Elbow:
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...
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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...
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Modifiers:
Master Modifier 25 Following These Expert Tips
Haphazardly using 25 on all claims will lead to payer scrutiny. With payers cracking d...
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ICD-10:
Underlying Condition Will Be Key to Choosing Pathological Fracture Diagnosis
This common diagnosis supporting vertebroplasty or kyphoplasties will become more inclus...
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Reader Question:
Pick Your Prominent Hardware Code
Question: My physician’s note states, “Previous incisions incised.....bluntl...
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You Be the Coder:
Synovectomy Including Debridement of Cyclops Lesion
Question: How would I code arthroscopic partial synovectomy including debridement of cyc...
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