Are you tired of dealing with coding errors and denied claims for orthopedic injections? Inaccurate coding for orthopedic injections can significantly impact your practice's revenue. Here's how you can master orthopedic billing, ensuring accuracy and maximizing reimbursements.
Accurate billing for orthopedic injections is essential for ensuring proper compensation for your services. Each type of injection, whether diagnostic or therapeutic, comes with specific codes that must be used correctly to avoid claim denials.
Arthrographies are diagnostic injections where a contrast dye is used to visualize the injury, usually followed by a radiologic examination. Here’s how to handle the coding:
For wrist arthrography, you need to bill two codes together: 25246 (for the injection procedure) and 73115 (for the radiologic examination). These codes represent a complete procedure, so additional fluoroscopy codes like 76000 should not be billed separately.
Arthrography codes also vary by the anatomical site:
For all these procedures, the radiologic exam code 73115 should be billed along with the injection code.
When it comes to therapeutic injections, such as injecting anesthetics or corticosteroids, the coding rules differ slightly:
If you inject an anesthetic like Marcaine into a joint with fluoroscopic guidance but without contrast dye, use the joint injection code based on the joint size and add the fluoroscopy code 76000.
The codes are as follows:
For injections involving medications like cortisone, use the injection code appropriate to the joint size and the specific HCPCS code for the medication. For cortisone, it is J0810. Ensure to include the cost of the medication in your billing.
You may bill for an office visit (Evaluation and Management, or E/M) in addition to the injection, under specific circumstances:
If a patient presents a new problem and an injection is performed after examination and discussion, you can bill for the office visit.
For example, use code 99213 with a modifier -25 (distinctly identifiable E/M service by the same physician on the same day of the procedure) along with the injection code 20610*.
If the patient returns for a follow-up visit specifically for the injection after a previously discussed treatment plan, you typically only bill for the injection––not the office visit.
To ensure efficient coding and minimize errors in orthopedic billing, here are some key strategies:
Use EHRs to capture detailed patient encounter information. This includes examination findings, diagnostic tests, and treatment plans, which are crucial for accurate coding.
Implement coding checks and validation rules in your billing software to flag potential errors before claims submission. This helps in maintaining coding accuracy.
Use coding assistants within your EHR systems. These tools suggest appropriate codes based on the documented information, helping you comply with orthopedic coding regulations.
These can analyze historical documentation patterns and highlight areas for improvement, ensuring your documentation aligns with medical billing standards.
Adhere to Health Insurance Portability and Accountability Act (HIPAA) standards to safeguard patient information during electronic claims submission.
Orthopedic practitioners often face demanding schedules, and the complexities of orthopedic coding add another layer of challenge. Outsourcing your orthopedic billing and coding to experts such as Medical Billers and Coders (MBC) can be a strategic move. Here’s why:
Take Action Today to Obtain Complete Reimbursements for Orthopedic Injections!
Contact MBC today to discover customized solutions for your orthopedic billing needs. Call us at: 888-357-3226 or email us at: info@medicalbillersandcoders.com to speak with our experts.
A: Yes, if the injection is for a new problem discussed and agreed upon during the visit. Use code 99213 with a modifier -25 alongside the injection code.
A: Orthopedic billing codes should be reviewed and updated annually to stay compliant with current regulations and coding guidelines.
A: Use reputable sources such as the American Academy of Orthopaedic Surgeons (AAOS), American Medical Association (AMA), and the Centers for Medicare & Medicaid Services (CMS) for the latest guidelines and best practices.
