At the 11th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference in Chicago on June 15, Ellis Medical Consulting Owner and President Stephanie Ellis, RN, shared 15 key current procedural terminology coding issues for orthopedic and spine driven ASCs. Ms. Ellis said some unexpected changes to the CPT coding system released by the American Medical Association last year can trip up some coders if they don't pay special attention to learning the new add-on codes and bundles for common procedures. Add-on codes, as a general rule, will be paid on the second level by many payers, Ms. Ellis said.
Below are Ms. Ellis’ 15 focus areas for orthopedic and spine centers.
1. Knee replacement procedures.
2. Dupuytren's contracture and deQuervain's procedures for joint relief in hands.
3. Carpometacarpal joint arthroplasty, is often performed for arthritis and which sometimes uses "tightrope" devices that must be billed as implants.
4. Subtalar arthroereisis procedures in which an implant is inserted in the heel. Ms. Ellis said these procedures are not billable to Medicare or Blue Cross plans because they are not viewed as medically necessary.
5. Arthroscopic subacromial decompression procedures, which may need to be coded as either a debridement or unlisted scope code since the AMA's latest revisions, which relegated decompression to an add-on code.
6. Injections for post-operative pain control, which should not be billed to Medicare, and centers must pay specific attention to using separate physicians for the injection or catheterization than the surgeon who performs the surgery. There are requirements on anesthesiology treatment, as well.
7. Meniscus procedures, which now use add-on codes.
8. ACL repairs, reconstructions and other procedures.
9. Epidural steroid or translaminar injections.
10. Transforaminal epidural injections, which should not be confused with general epidural steroid injections that may also be known as translaminar injections, Ms. Ellis warned.
11. Paravertebral facet joint or facet joint nerve injections.
12. Radiofrequency procedures were among the many pain-related codes the AMA changed in 2012, Ms. Ellis said.
13. X-stop spinal distraction procedures are now coded within category III.
14. Posterior laminotomy and laminectomy procedures for herniated discs.
15. Laminectomy procedures for spinal stenosis.
Senate Introduces Companion Medicare RAC Reform Bill
Tough Coding & Billing Issues for Pain Management
Below are Ms. Ellis’ 15 focus areas for orthopedic and spine centers.
1. Knee replacement procedures.
2. Dupuytren's contracture and deQuervain's procedures for joint relief in hands.
3. Carpometacarpal joint arthroplasty, is often performed for arthritis and which sometimes uses "tightrope" devices that must be billed as implants.
4. Subtalar arthroereisis procedures in which an implant is inserted in the heel. Ms. Ellis said these procedures are not billable to Medicare or Blue Cross plans because they are not viewed as medically necessary.
5. Arthroscopic subacromial decompression procedures, which may need to be coded as either a debridement or unlisted scope code since the AMA's latest revisions, which relegated decompression to an add-on code.
6. Injections for post-operative pain control, which should not be billed to Medicare, and centers must pay specific attention to using separate physicians for the injection or catheterization than the surgeon who performs the surgery. There are requirements on anesthesiology treatment, as well.
7. Meniscus procedures, which now use add-on codes.
8. ACL repairs, reconstructions and other procedures.
9. Epidural steroid or translaminar injections.
10. Transforaminal epidural injections, which should not be confused with general epidural steroid injections that may also be known as translaminar injections, Ms. Ellis warned.
11. Paravertebral facet joint or facet joint nerve injections.
12. Radiofrequency procedures were among the many pain-related codes the AMA changed in 2012, Ms. Ellis said.
13. X-stop spinal distraction procedures are now coded within category III.
14. Posterior laminotomy and laminectomy procedures for herniated discs.
15. Laminectomy procedures for spinal stenosis.
More Articles on CPT Coding:
A Need for EMR Templates in Orthopedics: Q&A With Dr. Ira KirschenbaumSenate Introduces Companion Medicare RAC Reform Bill
Tough Coding & Billing Issues for Pain Management