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Incorrect coding can lead to several difficulties within a practice, including denied claims, practice audits and decreased revenues. Wendy Owens-Frierson, CHM, CHI, CPC CPC-I, a billing product manager with Avisena, says many coding mistakes can be avoided by employing clear communication techniques between the physicians and coders. Ms. Owens-Frierson offers six tips to spine surgeons for improving communication with their coders.
1. Select the correct coding combination based on code requirements. Become familiar with the definitions for common codes and cite each code in the report instead of writing a surgery description. Additionally, become familiar with the requirements for each code and the modifiers.
2. Select the appropriate code for anterior and posterior procedures. When a physician is performing a procedure such as the lumbar interbody fusion, they either utilize the posterior lumbar interbody fusion (approaching the spine from the back), the anterior lumbar interbody fusion (approaching the spine through an incision in the abdomen). Citing the accurate code ensures the payor will be billed for the correct procedure type.
3. Document add-ons to your primary procedure. During surgery, when the physician finds more work that needs to be done than was initially expected, the physician can bill for their additional labors. For example, if a procedure crosses a spinal junction, (C5-T3), the physician should report the add-ons CPT 22554 (interspace preparation) and CPT 22585(additional interspace) instead of two stand-alone codes. If you are describing the procedure in a written report, be sure to specify these details in order to receive the correct reimbursement.
4. Sequence the CPT codes based on RVUs (Relative Value Units). Every CPT code has a RVU, the mechanism by which Medicare reimbursement is calculated attached to it. Length of procedures, surgical facility and professional liability expense are all reviewed when assigning RVUs. Citing the RVUs for the coders will clarify the work physicians have done for further accuracy in the billing process.
5. Specify unlisted procedure codes. If the physician is using an unlisted procedure code, such as CPT 22899 for spine procedures including cervical and lumbar spine surgery, he or she must clearly describe the procedure in the documentation, beginning with the initial incision, so the coder can identify how to accurately code and bill for the procedure.
6. When treating fractures, specify open, closed or percutaneous skeletal fixation procedure. Opened and closed procedures are billed differently and incur separate reimbursement values. In order to code for an open fracture procedure (22325), the physician makes a surgical incision as part of the treatment (exposed to the external environment). If an incision is not made, the fracture is treated as a closed procedure (22305) (exposed to the external environment and directly visualized). The Percutaneous skeletal fixation describes a fracture that is neither open nor closes, this procedure requires fixation (e.g. pins) is placed across the fracture site, usually under x-ray imaging (22842). Even if the patient arrives with an open wound associate with a fracture, the open procedure does not always indicate an "open fracture." If the wound is superficial and does not expose the fracture site, then the fracture is coded as closed.
Learn more about Avisena.
Read other coverage on orthopedic coding:
- 3 Critical Knee Arthroscopy Coding Pitfalls Impacting an ASCs Bottom Line
- 10 Billing and Collections Best Practices for Orthopedic and Spine Practices From Expert Sarah Wiskerchen
- Watch for These Coding Challenges for In-Office Procedures
Incorrect coding can lead to several difficulties within a practice, including denied claims, practice audits and decreased revenues. Wendy Owens-Frierson, CHM, CHI, CPC CPC-I, a billing product manager with Avisena, says many coding mistakes can be avoided by employing clear communication techniques between the physicians and coders. Ms. Owens-Frierson offers six tips to spine surgeons for improving communication with their coders.
1. Select the correct coding combination based on code requirements. Become familiar with the definitions for common codes and cite each code in the report instead of writing a surgery description. Additionally, become familiar with the requirements for each code and the modifiers.
2. Select the appropriate code for anterior and posterior procedures. When a physician is performing a procedure such as the lumbar interbody fusion, they either utilize the posterior lumbar interbody fusion (approaching the spine from the back), the anterior lumbar interbody fusion (approaching the spine through an incision in the abdomen). Citing the accurate code ensures the payor will be billed for the correct procedure type.
3. Document add-ons to your primary procedure. During surgery, when the physician finds more work that needs to be done than was initially expected, the physician can bill for their additional labors. For example, if a procedure crosses a spinal junction, (C5-T3), the physician should report the add-ons CPT 22554 (interspace preparation) and CPT 22585(additional interspace) instead of two stand-alone codes. If you are describing the procedure in a written report, be sure to specify these details in order to receive the correct reimbursement.
4. Sequence the CPT codes based on RVUs (Relative Value Units). Every CPT code has a RVU, the mechanism by which Medicare reimbursement is calculated attached to it. Length of procedures, surgical facility and professional liability expense are all reviewed when assigning RVUs. Citing the RVUs for the coders will clarify the work physicians have done for further accuracy in the billing process.
5. Specify unlisted procedure codes. If the physician is using an unlisted procedure code, such as CPT 22899 for spine procedures including cervical and lumbar spine surgery, he or she must clearly describe the procedure in the documentation, beginning with the initial incision, so the coder can identify how to accurately code and bill for the procedure.
6. When treating fractures, specify open, closed or percutaneous skeletal fixation procedure. Opened and closed procedures are billed differently and incur separate reimbursement values. In order to code for an open fracture procedure (22325), the physician makes a surgical incision as part of the treatment (exposed to the external environment). If an incision is not made, the fracture is treated as a closed procedure (22305) (exposed to the external environment and directly visualized). The Percutaneous skeletal fixation describes a fracture that is neither open nor closes, this procedure requires fixation (e.g. pins) is placed across the fracture site, usually under x-ray imaging (22842). Even if the patient arrives with an open wound associate with a fracture, the open procedure does not always indicate an "open fracture." If the wound is superficial and does not expose the fracture site, then the fracture is coded as closed.
Learn more about Avisena.
Read other coverage on orthopedic coding:
- 3 Critical Knee Arthroscopy Coding Pitfalls Impacting an ASCs Bottom Line
- 10 Billing and Collections Best Practices for Orthopedic and Spine Practices From Expert Sarah Wiskerchen
- Watch for These Coding Challenges for In-Office Procedures