Orthopedic coders need to keep up pace with the coding changes. Even a small coding error can lead to a potential fraud and result in a claim denial. There is a strong need to minimize the time being spent on combating coding issues. Providers need to place more focus on boosting their practice’s revenue, reducing denials and avoiding HIPAA audit risks.
Orthopedic Practices in 2015
As per the industry reports, orthopedic practices will be witnessing several changes and challenges in 2015. From CPT codes to ICD-10, practices will have to ensure compliance to the healthcare reforms and reduce claims denials in order to receive timely reimbursement for their rendered services.
Need for Trained Orthopedic Coders
Orthopedic surgeons cannot afford to leave dollars on the table. They need to ensure comprehensive, accurate medical coding for timely payments. It has become important to hire experienced coders for handling orthopedic coding complexities.
Coders at orthopedic practices need to have a good understanding of the different procedures and its specific terminologies. They also need to know the intricacies of coding for orthopedic surgeries and other such procedures. For instance, if they lack the knowledge of using a modifier for complex surgeries, the physician’s payment might get delayed or denied altogether.
Find Recourse in Outsourcing Billing
Providers can even outsource orthopedic billing services to a medical billing company because experienced orthopedic surgery coders are in high demand and short supply. Companies such as MedicalBillersandCoders.com offer orthopedic billing services spread across all over the US. They have a team of seasoned coding specialists who are well-trained in quick billing. They offer effective RCM solutions to enhance revenue and help providers save on their coding and billing expenses.
Avoiding Common Coding Errors
Orthopedic coders need to ensure that coding errors such as unbundling (not knowing when to apply modifier 59), failure to identify medical necessity of orthopedic diagnoses and not staying updated with specific rules for orthopedic surgery and other procedures are avoided. To get timely payments, coders need to avoid these common errors along with co-morbidities and inaccuracies due to complex medical rules.
According to RemitDATA, five unexpected orthopedic claim denials took place from October 19, 2013 to January 16, 2014:
- CPT code 99213: Outpatient doctor visit, level 3
- CPT code 97110: Therapeutic exercises
- CPT code 99214: Outpatient doctor visit, level 4
- CPT code 20610: Aspiration and / or injections; major joint or bursa
- CPT code 99203: Outpatient doctor visit, new patient, level 3
To avoid these denials in future, it is important to track the reason behind it and streamline the coding process accordingly. It calls for diligent insurance verification, selection of automated billing service and collection of accurate patient information.
Being Prepared for Coding Changes
The AMA rolls out various changes to its CPT code set every year. The CPT changes were rolled out in January 2014 for orthopedic coding. The codes related to removal of foreign bodies, knee procedures and prosthesis removal were changed. Changes were also made in the arthroscopic knee synovectomy codes 29875 and 29876. More changes will be introduced on January 01, 2015 by AMA.
MBC is considered the most dependable and efficient orthopedic billing services in Florida. Their Texas orthopedic billing services are quite sort after too along with other 42 specialties of medicine.