Wiki Hip, Knee, & Hand surgeries

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monicahkfan

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Hello,
We have new drs that will start doing hip, knee and hand surgeries. Does anyone have helpful websites, books, etc that would help? TIA!
 
Your really going to need to follow what the patient's insurance plan is. Especially for shoulders. The CMS NCCI orthopedic surgery guidelines were updated this year. If the patient's insurance is Medicare, replacement or anyone who follows Medicare guidelines, your really going to be restricted in what you can bill. Basically on shoulders, if it hits an edit, you can't bill it. If the insurance does not follow Medicare, then I would bill it. CMS specifically states that the shoulder is a single anatomical location.

Knees you have to really know why a procedure is being performed and 29874 and 29877 can only be reported if they are the only procedures performed.

Hands are a fight. Even though procedures are performed on separate digits, the insurance company is going to bundle them. Keep a copy of the op note and have all procedures marked and underlined so that you are ready for the appeal.
 
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