Orthopedic Coding Alert

Critical ways you can combat carrier challenges

CPT coding is not an exact science, and the AMA hasn't yet released a code for every procedure that orthopedic surgeons perform. Therefore, orthopedic coders resort to unlisted-procedure codes almost every week. But unlisted-procedure codes don't have to mean automatic denials or write-offs. Read on for tips on how to hone your reporting strategies and boost your bottom line. Choose Unlisted Over Close Coding When CPT doesn't offer you a specific code for your surgeon's service, you must report an unlisted-procedure code such as those listed in the Clip N Save article later in this issue.
 
Coders may be tempted to avoid reporting unlisted- procedure codes because doing so too often can lead to a denied claim or a long delay in reimbursement. Because of this, some coders erroneously report codes that are close to the procedure instead of the appropriate section's unlisted-procedure code. That's not a good habit to acquire, for a number of reasons.

The primary reason this is inappropriate is that you-ll face accusations of incorrect coding. -Selecting a code that is -close- is not compliant coding,- says Marvel J. Hammer, RN, CPC, CHCO, president of MJH Consulting in Denver.  Use Category III Codes When You Can In addition, if you don't report unlisted-procedure  codes, you may eliminate your chances of ever seeing a permanent CPT code assigned to the service.

One way that the AMA tracks the need for new codes is through the unlisted procedures that are reported. At some point, the association may create a Category III code for further tracking.
 
Category III codes exist to help the AMA determine whether there is a need to create a CPT code for the service, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

If Medicare never receives submissions of the Category III codes, the services will never get Category I CPT codes assigned to them. Modifiers Don't Take the Place of Unlisted  If your practice avoids reporting unlisted-procedure codes by simply modifying existing codes with modifiers 22 (Unusual procedural services) and 52 (Reduced services), you may be shooting yourself in the foot because of the way CMS assigns relative value units (RVUs) to codes.

-When it's time to create a CPT code for a procedure, if offices have been reporting the procedure using unlisted-procedure codes, the specialty will receive new RVUs for the new code. If they-ve been using an existing code with a 22 or 52 modifier attached, the specialty will have to steal RVUs from established codes to fund the new code,- Cobuzzi says. Enlist Outside Help Medical technologies often evolve faster than the CPT manual, and [...]