Orthopedic Coding Alert

Consolidated billing may be a hurdle, but these practices triumphed and collected their due Coders who write off x-ray fees for SNF patients could be forfeiting thousands by not following up on the technical component of the x-ray fee. If you saw $1,000 sitting on the sidewalk, would you pick it up? Most people would answer a resounding "Yes!" to this question. But many orthopedic practices have grown so tired of trying to collect the technical portion of x-rays from SNFs that they no longer attempt to capture those dollars. If this describes your practice, don't give up hope. We-ve gathered success stories from orthopedic coders in the field whose tenacity paid off, and they are bringing in x-ray money without a struggle. Follow their seven steps to put your SNF x-ray collections in the black. The problem: When coding for skilled nursing facility (SNF) patients who present to your orthopedic practice for x-rays, you should bill the physician's x-ray interpretation to Medicare with modifier 26 (Professional component) appended, but you must bill the technical component (the radiology clinician's portion) directly to the SNF. Many orthopedic practices find this procedure so frustrating that they tend to write off the x-rays- technical portion, which can run anywhere from $17 for 73020-TC (Radiologic examination, shoulder; one view; technical component) to $52 for 72114-TC (Radiologic examination, spine, lumbosacral; complete, including bending views). But if your practice sees SNF patients frequently, these fees can add up, and writing them off is not a valid solution. Even at the lower end of the spectrum, if you see only 50 SNF patients for shoulder x-rays each year, you-ll forfeit $850 if you fail to ask the SNF for your rightful reimbursement. More realistically, however, you-ll perform a variety of x-ray sites and views, leaving you seeking thousands in technical component reimbursement each year. Two practices report that they have successfully established systems to bring in these fees. Here's what they did to collect. 1. Determine the Patient's SNF Status Often, the first hurdle is determining whether a patient is from a SNF, because a family member may bring the patient to the practice. The ideal situation would be to determine the patient's SNF status when he calls to make the initial appointment. If the patient is in a SNF, the front-office staff should get authorization to x-ray the patient and record the name of the SNF staffer who gave authorization. But even if your receptionist tries to identify all SNF patients during the initial phone call, you may still miss some. In those cases, "You kind of need to be a detective," says Angie Good, CPC, coder at the Orthopaedic Institute of Ohio. "Observe who brought [...]