Orthopedic Coding Alert

Answer: Because you are having difficulty making your point with the nurse reviewers, you may need to push a bit for a medical director to review your case. Of course, the ideal situation would be to have your case reviewed by an orthopedic spine surgeon. If you are able to present your case to a higher authority, have your surgeon dictate a concise letter explaining what he or she did and why he or she feels it is appropriate to report the two codes separately. Physician-to-physician contact is often best in these situations. Since you were unsuccessful in swaying the carrier with your documentation from Medicares Correct Coding Initiative and The American Academy of Orthopaedic Surgeons Global Service Data for Orthopaedic Surgery, you may want to submit your coding scenario to the North American Spine Society (NASS). There a fellow spine surgeon will review it. NASS offers fax forms for submitting your coding review requests. Contact them at www.spine.org for instructions on how to initiate a review.