Orthopedic Coding Alert
Avoid Automatic Resends
Question: When we know that the carrier has made a mistake in denying a claim, can I just resend the original claim again, or is it just going to be denied again?
North Dakota Subscriber
Answer: While simply resending a claim that the carrier erroneously denied sounds like a logical, easy answer, in the end it may cost you more time and effort. The carrier denied the claim for a particular reason during the first round of submission. If you don't address that reason, your claim will likely just come back to you as a denial again.
Possibilities: Many things can go wrong that will result in an erroneous denial. Problems with patient pre-authorization, physician credential with the carrier, an oversight on your part on the claim, or problems with the insurance carrier's processing systems could all cause an incorrect denial.
Good practice: Rather than automatically resending the claim, contact your carrier representative. Discuss the denial with the representative and figure out why the claim was denied. A short phone call could save you much more time in the long run.
Orthopedic Coding Alert
- Shoulders:
Get on the Fast Track to Shoulder Claim Success By Tackling These 3 Scenarios
Bonus: Learn when your physician's requests will throw your coding out of joint. To properly [...] - Anatomy:
Shoulder Anatomy Can Be Your Key to Quick Code Selection
Learn what's where to make your coding easier.Because the shoulder is highly mobile, it is [...] - Auditing:
Check Your HPI, Risk IQ With Pre-op Exam Case Study
Hint: Your orthopedist's recs are the ones to count under mgt options.When a patient needs [...] - You Be the Coder:
Check Your Modifiers for Shoulder Scopes
Question: An orthopedist in my practice arthroscopically repaired a rotator cuff on the left shoulder, [...] - Auditing:
MDM : Weigh Surgical Risk to Snag the Correct E/M Level
These definitions take the mystery out of moderate vs high surgical management options.If you audit [...] - Reader Questions:
'Joint Fracture' Is a Misnomer
Question: Which diagnosis code should I use for an SI joint fracture?Ohio SubscriberAnswer: When looking [...] - Reader Questions:
Stick With 29866 for OATS
Question: What code would I use for a knee arthroscopy with OATS procedure? In the [...] - Reader Questions:
'With or Without' Includes With
Question: What exactly does "with or without internal or external fixation" mean when a CPT [...] - Reader Questions:
Coding for PCL Debridement
Question: If the orthopedist debrides a ganglion cyst of the posterior cruciate ligament, should I [...] - Reader Questions:
Consider 20245 for Femur Biopsy
Question: Our surgeon performed a femur biopsy, and the pathology report came back as "metastatic poorly [...] - Reader Questions:
Target Symptoms to Assign Dx Code
Question: Which diagnosis code should I use when my orthopedist's documentation indicates the patient has [...] - Reader Questions:
Time Is the Key for FCEs
Question: Our physician is performing functional capacity evaluations (FCEs) in the office. Which code should [...] - Reader Questions:
Avoid Automatic Resends
Question: When we know that the carrier has made a mistake in denying a claim, [...] - Reader Questions:
Multiple X-Ray Views
Question: We performed x-rays in the office for a patient with a wrist injury. We [...]
