Orthopedic Coding Alert

Put these timing tips to work for you Problem: Physicians and mid-level providers, scurrying to stay within a reasonable time table of their schedule, are often tardy as the ever-increasing administrative burdens of prior authorizations, referrals, pharmacy clarifications or substitution requests, "quick phone calls" to the hospital, or curbside consults continue to mount. Add to this a paltry reimbursement structure with the two-steps-forward, one-step-back federal reimbursement scheme, and providers are finding it ever more problematic to see enough patients to maintain cash flow. Solution: The key under such pressures is accurate coding -- both diagnostic (ICD-9) and therapeutic (CPT). Get the Surgeon on Board The signature line of the CMS-1500 form clearly states that the provider is liable for billing done by himself or a designee in all of the following ways: --personally --financially --civilly --criminally. But many providers may still appear to see "interruptions" regarding proper coding as a nuisance. Instead, they should see it as a time for clarification, optimizing reimbursement with correct coding and keeping them out of trouble. They should appreciate the clarification because the providers ultimately are responsible for the codes billed. Also, providers should direct which ICD-9 and CPT codes are submitted because they can most accurately and specifically depict what occurred in the clinical encounter. Here's why: The coder was not there, and regardless of his level of expertise, he often needs assistance when confusion exists surrounding a code. The doctor is responsible for providing this clarification. Approaching the physician should be a collaborative, unimpeded and open-ended process because both parties -- the coders and the providers -- are tying to achieve the same result: accurate coding. Consider this: The coder sometimes needs to point out the lack of an open communication channel because many physicians may feel threatened or anxious discussing CPT and/or ICD-9 codes. Coding may be an area in which they have little expertise. Saying, "I don't know," although important in medicine, is often not part of a provider's vernacular. Moreover, many of us don't like to admit we are wrong. Steer Clear of These 3 Conversation Don-ts To make the most of your conversation, plan ahead. Simply having a conversation at the right time may be all you need to do. Don-t: Do not attempt this verbal exchange when the doctor has just been up all night on-call. Don-t: Do not try the conversation when the doctor has just had one of his more histrionic or high-maintenance patients. Don-t: You should avoid trying to have this conversation in the middle of clinical hours when everyone and everything is running late. Timing is everything, and this is no exception. Master These Tactics for Successful Conversations Do: Be pre-emptive -- bring [...]