Strategies to Wrap up Your Orthopedic Coding Payments Every Time

An orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day. Here, you will need to understand the multiple-scope rule to determine which procedures you can actually claim -- and get the payments for.

Remember:

In the orthopedic practice, the multiple-scope rule applies mainly to shoulder and knee procedures. But then it also affects those of the elbow, wrist and hip. In contrast, it does not apply to ankle or metacarpophalangeal (MCP) arthroscopy; and it doesn't have a say on arthroscopically-aided procedures. That apart, some surgical knee arthroscopies are excluded from the family.

Here are some sure-success tips to seal your coding every time.

You must first know why and when the multiple-endoscopy rule applies before thinking about how to apply it. This rule is Medicare's method to avoid paying twice (or for that matter more for 'inclusive services by reimbursing only a part of any scope carried out at the same time as another scope of the same basic type.

You should also include the 'base' procedure. For example, the physician has carried out a diagnostic shoulder arthroscopy (29805) in addition to shoulder arthroscopy for repair of SLAP lesion (29807). As such, how does the multiple-scope rule apply? Family codes always include the work involved in the base code while a surgical scope always includes the diagnostic scope of the same type. Here you would go for only 29807. And as far as diagnostic shoulder arthroscopy followed by arthroscopic limited debridement is concerned, you should once again report only the most extensive procedure. Here you should go for 29822.

Say for instance the surgeon carries out two scopes in the family, neither of which is the base procedure. Here you should go for both codes. Therefore, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for complete synovectomy, you would report both 29819 as well as 29821.

Under the multiple-scope rule, Medicare will shell out the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay for any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.

New modifiers? Stay alert!

Modifiers play a key role in your day to day coding life. As such, you stand a better chance of getting the payments if you are well-versed with everything relating to modifiers. As an orthopedic coder, you need to stay on top of all modifier changes which in turn will have an impact on your orthopedic coding practice.

In 2011, it's important that you are aware of a few just-in modifiers as well as some changes to the present CPT modifiers.

This year add several just-in modifiers to your coding armory and update the descriptors for various others you might use regularly. Say for instance, you can use modifier GU (Waiver of liability statement issued as required by payer policy, routine notice) for dates of service (DOS) January 1, 2011 and after that.

There may be times when it's proper to report modifier GU in place of the revised stamdby modifier GA (Waiver of liability statement on file; individual).

In addition, three existing CPT modifiers (Source CPT http://www.supercoder.com/cpt-codes) now cover non-physician providers in the descriptors, as follows:

Modifier 76 -- Repeat procedure or service by same physician or non-physician provider

Modifier 77 -- Repeat procedure or service by another physician or NPP

Modifier 78 -- Unplanned return to the operating/procedure room by the same doctor or NPP following initial procedure for a related procedure during the postoperative period).

Modifier 78 -- Unplanned return to the operating/procedure room by the same physician or NPP following initial procedure for a related procedure during the postoperative period).

In earlier years, some payers did not allow non-physician providers to report their services with these modifiers as they purposely addressed “physician" care. If you update the descriptors, it should be much easier for you to report situations represented by modifiers 76, 77, or 78 to your payers.