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In-office procedures present the most challenges for orthopedic practice coding, says Mu Medical Management Billing Supervisor Ms. Courtney Henderson, CPC, CPC-P. The most common complications are the result of physicians confusing multiple injection codes as well as attaching inappropriate diagnoses to a procedure report.
"A lot of doctors don't choose the right diagnoses or all the diagnoses," says Ms. Henderson. Physicians often cite "pain" as the reason for performing a procedure; however, the payor requires a more specific diagnosis, such as joint degeneration, in order to reimburse for the procedure.
If "pain" is the only diagnosis for an in-office injection, the coder can add the -59 modifier to the claim. Then, if the claim is denied, it must be written off if the patient does not sign an ABN and if the provider is contracted.
Once the diagnosis is correct, coders must ensure physicians have accurately reported on their procedures performed. This is complicated by multiple in-office injections, specifically the trigger point codes 20552 and 20553.
"The codes, 20552 and 20553, cannot be billed at the same time and doctors misuse these codes by thinking the procedure is done by an actual injection, but it's not," says Ms. Henderson.
The 20552 code is appropriate when physicians report performing one to two injections while the 20553 is appropriate when reporting three or more injections. Physicians will often record both codes in order to communicate they performed multiple procedures. However, the codes cannot be billed at the same time because they are by muscle groups injected, not by the number of injections the physician administered.
Additionally, when performing multiple injections, the physician must code for each type of injection. The coding becomes complex when physicians record several procedures at once as well as equipment use, such as ultrasounds, for reimbursement.
Physicians must also understand the payor rules for multiple injections and procedures. Some payors will not reimburse for several procedures performed in the same day, which can be particularly challenging for physicians located in rural areas whose patients travel several miles for treatment.
"We do the best we can and try to educate the providers and keep up on all the payor rules," says Ms. Henderson. "The physicians can be pretty limited as to what they can do for the patients they see."
Contact Ms. Henderson at cseal@mumedical.com.
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read other coverage on medical coding.
-14 Points About the End of Consultation Codes and Onset of Lower Reimbursements for Orthopedic Surgeons and Other Specialists
-Guide to Spinal Coding From Medtronic's Top Coding Analyst
-Navigating CPT Category III 'Emerging Technology' Codes for Orthopedic Surgery
In-office procedures present the most challenges for orthopedic practice coding, says Mu Medical Management Billing Supervisor Ms. Courtney Henderson, CPC, CPC-P. The most common complications are the result of physicians confusing multiple injection codes as well as attaching inappropriate diagnoses to a procedure report.
"A lot of doctors don't choose the right diagnoses or all the diagnoses," says Ms. Henderson. Physicians often cite "pain" as the reason for performing a procedure; however, the payor requires a more specific diagnosis, such as joint degeneration, in order to reimburse for the procedure.
If "pain" is the only diagnosis for an in-office injection, the coder can add the -59 modifier to the claim. Then, if the claim is denied, it must be written off if the patient does not sign an ABN and if the provider is contracted.
Once the diagnosis is correct, coders must ensure physicians have accurately reported on their procedures performed. This is complicated by multiple in-office injections, specifically the trigger point codes 20552 and 20553.
"The codes, 20552 and 20553, cannot be billed at the same time and doctors misuse these codes by thinking the procedure is done by an actual injection, but it's not," says Ms. Henderson.
The 20552 code is appropriate when physicians report performing one to two injections while the 20553 is appropriate when reporting three or more injections. Physicians will often record both codes in order to communicate they performed multiple procedures. However, the codes cannot be billed at the same time because they are by muscle groups injected, not by the number of injections the physician administered.
Additionally, when performing multiple injections, the physician must code for each type of injection. The coding becomes complex when physicians record several procedures at once as well as equipment use, such as ultrasounds, for reimbursement.
Physicians must also understand the payor rules for multiple injections and procedures. Some payors will not reimburse for several procedures performed in the same day, which can be particularly challenging for physicians located in rural areas whose patients travel several miles for treatment.
"We do the best we can and try to educate the providers and keep up on all the payor rules," says Ms. Henderson. "The physicians can be pretty limited as to what they can do for the patients they see."
Contact Ms. Henderson at cseal@mumedical.com.
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Read other coverage on medical coding.
-14 Points About the End of Consultation Codes and Onset of Lower Reimbursements for Orthopedic Surgeons and Other Specialists
-Guide to Spinal Coding From Medtronic's Top Coding Analyst
-Navigating CPT Category III 'Emerging Technology' Codes for Orthopedic Surgery