Confront Tough Orthopedic Billing & Coding Challenges Before It’s Too Late!
Agenda 1. The MRI Isn’t Always Right (slides 4-8) 2. BONUS: Sneak Peek at 2018 ICD-10-CM Changes for Orthopedics (slides 9-13)
Is your orthopedic practice losing hard-earned dollars due to incorrect coding and billing? We’ve got you covered!
Let’s Consider This Orthopedic Medical Coding An orthopedic surgeon states in the Scenario 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?
Solution: Look to Surgeon’s Statement, Not MRI Findings Use code 29880, which covers everything the surgeon performed. When coding an operative report, base your orthopedic diagnosis codes and orthopedic procedure codes on the operative report, not the MRI findings.
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 CPTÂŽ copyright 2016 American Medical Association All rights reserved
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.
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.
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.
BONUS Don’t 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?
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!
For Example Before Oct. 1
Post Oct. 1
M48.06 Spinal stenosis, lumbar region
M48.061 Spinal stenosis, lumbar region without neurogenic claudication M48.062 Spinal stenosis, lumbar region with neurogenic claudication
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.
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.
Too much to learn, too little time? Here are some top resources that need to be up to date to ensure ICD-10 changes don’t 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
Let TCI SuperCoder do the update work for you. Start your free trial of Orthopedic Coder today www.supercoder.com/occ
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