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Confront Tough Orthopedic Billing & Coding Challenges Before it's Too Late!

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Let’s Consider This Orthopedic Medical Coding Scenario An orthopedic surgeon states in the operative report that he did both medial and lateral arthroscopic meniscectomies. – PowerPoint PPT presentation

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Title: Confront Tough Orthopedic Billing & Coding Challenges Before it's Too Late!


1
Confront Tough Orthopedic Billing Coding
Challenges Before Its Too Late!
2
Agenda
  • The MRI Isnt Always Right (slides 4-8)
  • BONUS Sneak Peek at 2018 ICD-10-CM Changes for
    Orthopedics (slides 9-13)

3
Is your orthopedic practice losing hard-earned
dollars due to incorrect coding and billing?
Weve got you covered!
4
Lets Consider This Orthopedic Medical Coding
Scenario
An orthopedic surgeon states in the operative
report that he did both medial and lateral
arthroscopic meniscectomies.
All supporting documentation in the chart states
medial and lateral meniscectomies were performed.
But the MRI report refers to only a medial
meniscus tear.   Challenge Should you report
both?
5
Solution Look to Surgeons Statement, Not MRI
Findings
Use code 29880, which covers everything the
surgeon performed.
29880 Code Descriptor Arthroscopy, knee,
surgical with meniscectomy (medial AND lateral,
including any meniscal shaving) including
debridement/shaving of articular cartilage
(chondroplasty), same or separate compartment(s),
when performed
When coding an operative report, base your
orthopedic diagnosis codes and orthopedic
procedure codes on the operative report, not the
MRI findings.
CPT copyright 2016 American Medical
Association All rights reserved
6
Remember
  • MRIs sometimes show the lateral meniscus as
    normal even when further examination via the
    arthroscopy reveals previously unseen
    abnormalities.
  • To avoid confusion and to support medical
    necessity, the op report should address the
    abnormalities of the lateral meniscus that
    warranted the partial lateral meniscectomy.

7
Reality Check
  • Everyone makes mistakes, so documentation
    mistakes by the surgeon are possible.
  • If you see red flags that suggest the
    documentation is inaccurate, confirm the medical
    record is correct.

8
Final Takeaway
  • Base your coding for the surgery on the operative
    report, not the MRI.
  • Query the orthopedic surgeon if he did not
    include documentation and postoperative diagnoses
    that support reporting both medial and lateral
    meniscectomies.
  • Source Orthopedic Coding Alert, a monthly
    publication included in Orthopedic Coder. To
    learn more about this online solution, visit
    www.supercoder.com/occ.

9
BONUS Dont forget to incorporate 2018 ICD-10-CM
changes into your clean-claim plan!
Do you know which of the 800 changes will impact
orthopedics the most?
10
For orthopedics, a few minor changes lead to a
whole lot of updates!
  • Spinal stenosis
  • Non-pressure ulcers
  • Phalanx fractures of fingers and toes
  • ATV accidents
  • And more!

11
For Example
  • Before Oct. 1
  • M48.06
  • Spinal stenosis, lumbar region
  • Post Oct. 1
  • M48.061
  • Spinal stenosis, lumbar region without neurogenic
    claudication
  • M48.062
  • Spinal stenosis, lumbar region with neurogenic
    claudication

12
More Examples
  • Phalanx fracture codes for the finger (S26.6-)
    and toe (S92.5-) will see a language change from
    medial phalanx to middle phalanx.
  • Subluxation and dislocation codes (S63.12-) for
    thumb interphalangeal joints will get cleaned up
    to remove references to proximal and distal.
  • Non-pressure chronic ulcers (L97.- and L98.-) get
    additions to help when coding these
  • muscle involvement without evidence of necrosis
  • bone involvement without evidence of necrosis
  • other specified severity.

13
Get a handle on the long list of new, revised,
and deleted codes for orthopedics, including
  • New V86.06XA, Driver of dirt bike or motor/cross
    bike injured in traffic accident, initial
    encounter
  • Revised S62.311S, Displaced fracture of base of
    second metacarpal bone, left hand, sequela
  • Deleted S63.131A, Subluxation of proximal
    interphalangeal joint of right thumb, initial
    encounter
  • Tip Review 2018 changes to ICD-10 codes for
    orthopedics by referring to an updated ICD-10
    manual or online code search tool like Orthopedic
    Coder.

14
Too much to learn, too little time?
  • Here are some top resources that need to be up to
    date to ensure ICD-10 changes dont cause
    denials
  • ICD-10-CM Code Set
  • Including Online Coding Software
  • ICD-10-CM Official Guidelines
  • CPT to ICD-10-CM Crosswalk
  • Claim Scrubber
  • LCDs
  • Job Aids

15
Let TCI SuperCoder do the update work for
you. Start your free trial of Orthopedic Coder
today www.supercoder.com/occ
  • Orthopedic Coding Alert
  • Online CPT, HCPCS, and ICD-10-CM Code Search
  • Official Guidelines
  • Lay Terms
  • CCI Edits Checker
  • Medicare Fee Schedules
  • LCD and NCD Lookup
  • Crosswalks
  • CMS-1500 Scrubber
  • Code Update Analysis
  • 38 AAPC-Approved CEUs

16
Our Products
17
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