Correct Coding and Billing of Orthopaedic Procedures to Get Proper Reimbursement

Correct Coding and Billing of Orthopaedic Procedures to Get Proper Reimbursement

Like all medical practitioners, orthopedic surgeons are also concerned about getting paid properly on the basis of the work that they do in hospitals and at their practices. Being, as it is, primarily related to medical issues pertaining to bones and the skeletal structure, orthopedics often involve multiple diagnostic tests and procedures, generating a lot of documentation and thus, a lot of coding. These tests and procedures also have to follow the stated orthopedics guidelines, which change and add to the complexity of the task facing every orthopedic surgeon.

It is, therefore, important to get the coding correct at the outset for the services rendered. In the instance that incorrect coding is found for the service provided, there is a possibility that your orthopedics coding reimbursement payment may be reduced, delayed or cancelled altogether. This would mean that the costs of providing that procedure will not be reimbursed, and that your hospital, practice or clinic would lose money for services that it has already rendered. The responsibility for this falls squarely on the primary surgeon.

The reason behind it is that you are the one providing the services, be it in a hospital, office or in the operating room; therefore, you are the sole responsible person, which also makes you liable for the errors. Therefore, it is essential for you, as a responsible medical professional, to learn and be aware of the ICD 10 codes. It is not advisable to use Electronic Health Record (EHR) systems for coding. It is very important that physicians and other staff use the necessary documentation that will help ease in the transition to ICD-10-CM, and make it as seamless as conceivably possible. If you do not know the new code descriptors or codes, the documentation will not match with nomenclature of ICD-10-CM and will not provide the appropriate and specific code – this is where a large number of claims fail to pass muster and orthopaedics coding reimbursement becomes problematic.

You cannot rely 100% on your staff for correcting your code, simply because your staff will never have the same stake that you have in ensuring proper coding; regardless of their training or expertise. Being aware of the coding requirements and orthopedics guidelines of a procedure is always going to save you time, money and effort in the long run. This will help you increase your revenues and profit and be a better value generator in your professional career.

The Centers for Medicare & Medicaid Services (CMS) has clarified the documentation requirements and policy requirements for the use of CPT® modifier -25 used with E/M services. The implementation of ICD-10-CM will not impact how you report CPT codes, including proper modifier placement. Thus, being aware of the current state of coding and remaining aware of orthopaedics guidelines has become an incredibly important part of being an orthopaedic surgeon.

Source by Steve Gray Stevenson

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