Orthopedic Coding Alert

Note: Part two of a three-part series reviews the essentials of billing for selected supplies and orthotics for the extremities.

Correct use of the Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) codes will supplement CPT codes for reporting supplies and services. CPT codes are referred to as Level I codes, and HCPCS as Level II codes. (Level III codes are also HCPCS codes, but refer to codes used by local Medicare carriers.)

CPT code 99070 (supplies and materials [except spectacles], provided by the physician over and above those usually included in the office visit or other services rendered [list drugs, trays, supplies or materials provided]) indicates supplies that can be billed separately from an evaluation and management (E/M) outpatient service. But to be successful in garnering reimbursement, you must use HCPCS Level II codes instead of (or in addition to) the CPT code.

Things You Must Know About HCPCS Codes

Medicare, Medicaid and most commercial carriers require orthopedists to use HCPCS codes for supplies and orthotics. Carrier discretion on reimbursement for HCPCS coded items is wide. Moreover, the same insurer often offers different plans to subscribers. In other words, it cannot be assumed that all Blue Cross/Blue Shield plans pay for a fiberglass cast; some do, some do not.

Most consumers fail to read the fine print of their policies when subscribing to a particular health plan. As a result, orthopedic practices must all too often impart the unwelcome news of what a plan will or will not cover. In many cases, the only way to know is for the practice to check with the carrier.

Even in an office setting, most supplies are considered incident to a physicians services. The supplies cannot be billed separately. If a physician bandages a knee to support it and minimize pain, the HCFA guidelines emphasize the physician is expected to have the bandage material on hand as a matter of routine practice, and its cost is included in the bill for the service (i.e., the appropriate E/M code).

In fact, the orthopedist has very few options for billing separately for supplies. Although a physician can bill for a replacement castusing the appropriate 29000-29799 series codeonly the CPT for the cast can be reported. If the patient is given materials to take home (e.g., tape) in conjunction with cast care, those supplies can be billed using the correct HCPCS code.

The complexities of billing can be staggering. If the patient is given only one roll of tape to take home and the physician ordered the tape in units of 10, the unit amount must be carefully recorded. Only the cost of one roll will be reimbursed.

Note: Patient education materialse.g., a [...]