Orthopedic Billing Codes

by | Mar 30, 2021 | Medical Billing

Medical coding and billing is one of the most important aspects of any orthopedic practice, because it keeps revenue coming in, and without that the practice would quickly go under. Given its importance, it’s easy to see why there is so much emphasis placed on accurate coding and billing. Claim denials and delays will interrupt cash flow, and that will always create stress for a practice, because monthly bills and expenses have to be paid regardless of whether regular revenues are coming in or not. In order to ensure that such delays and denials are kept to an absolute minimum, here are some guidelines to follow in the preparation of medical billing claims for an orthopedic practice.

Keep abreast of all updates 

Every year there are changes to the Current Procedural Terminology (CPT) code set, and these are ignored at your peril. If your coding and billing is performed in-house, you need to be aware of all changes issued, so you can be sure to use any appropriate new codes. In any given year, there are generally several hundred updates applied to the code set, and your in-house personnel need to be educated about these, whatever they may be.

Avoid the most common reasons for denial 

In order to avoid the most common reasons for denial of a claim, you have to be aware of what those common reasons are. Duplicate claims and services are probably the single biggest reason that claims are denied by a carrier, so each claim should be scrutinized so as to avoid this. It’s important to be familiar with the fee schedule and stay within its guidelines. Make sure that patient information is correct when it’s gathered, and be diligent about verifying insurance information, because these go hand-in-hand with denials when anything is amiss.

Understand how ICD-10 changes have affected orthopedic billing codes 

Orthopedic coding and billing may have been more significantly impacted than any other area of medical practice by the recent ICD-10 updates. For one thing, laterality is fully addressed in ICD-10, whereas it was nowhere to be found in ICD-9. That means physicians must document right, left, and bilateral for all fractures and joint issues. In addition, it will now be necessary to specify the actual site on the body where service is delivered, rather than simply documenting spondylosis or spinal stenosis. Payers will require that a physician submitting a claim document exactly where injuries have occurred and what kind of treatment was delivered. It will also be necessary to identify the type of visit that a patient makes to your office, i.e. an initial consultation, a follow-up procedure, or a continuation visit.

Consider outsourcing 

Depending on the size of your orthopedic practice, it may be highly advantageous for you to consider outsourcing your coding and billing processes. One of the first advantages you should gain is fewer delays and denials of your submitted claims. Billing companies recognize that their reputation depends on accuracy and reliability, so they go to great lengths to make sure their team of coders are well-versed in all the current medical codes, and that they stay abreast of current developments and changes. Any company which doesn’t adhere to high standards of accuracy and reliability simply won’t be in business for very long.

When you outsource your coding and billing operation, you’ll relieve yourself of the necessity of hiring trained staff members to perform that function in-house, so you are likely to save money on monthly expenses due to the lower payroll costs. You will probably also notice an increase in profitability and a more consistent cash flow, because you have fewer denials and delays, and this can be very important in terms of keeping your orthopedic practice running smoothly. Outsourcing may not be right for every single orthopedic practice, but it has proven to be very helpful and very effective for a great many physicians already, and it has removed a great deal of stress from the coding and billing function. It might well be the best way for you to handle all the intricacies and complexities of orthopedic billing.

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