Is orthotics the same as orthopedics?

Is orthotics the same as orthopedics? If you are looking for an answer then you are at the right place. An orthotic is a device that supports and stabilizes a joint or weakened/injured body part, creating proper alignment, pressure relief, and management of pain while orthopedics is a branch of medicine that focuses on the care of the skeletal system and its interconnecting parts like bones, joints, tendons.

When you talk about orthopedic doctors, the term “orthopedic surgeon” is used by default as orthopedic surgeries are one of the more common medical procedures that people encounter. However, while all orthopedic surgeons are orthopedic specialists, all orthopedic specialists are orthopedic surgeons.

When you talk about Orthotics, it is a medical provider who has a Master’s Degree in prosthetics and orthotics. There are two types of orthotics like mass-produced Orthotics and Custom-made orthotics.

Mass-produced Orthotics are relatively inexpensive, no need for prescription to purchase, and doesn’t require an office visit to an orthotist while custom made orthotics can be expensive and some items may not be covered by insurance and need to have a prescription from a Physician, PA or Doctor of Physical Therapy.

Let’s understand some basics of orthopedics billing and orthotics billing:

Orthopedics Billing

It is observed that orthopedic practice mostly faces claim denials due to two factors such as duplicate claims or services and charge exceeds the fee schedule. But you can avoid both with simple preventive measures includes:

  • Making sure that patient information is correct when it’s collected
  • Being diligent about insurance verification
  • Working with an automated billing service

Recently changes in ICD-10 coding affect every medical specialty including orthopedic practice. In the following brief, you will understand various ways changes affect coding for your orthopedic practice.

Laterality

ICD-10 code sets as well as newer CPT codes require physician’s document right, left, or bilateral for many different conditions, including fractures and joint disorders.

Site Specificity

You need to document the specific area of the body based on many different diagnoses of your orthopedic practice. For example, if a diagnosis of spinal stenosis or spondylosis is made then you should indicate the specific spinal region or the claim will be denied.

Place of Occurrence

Your office needs to provide documentation of where injuries occurred to payers.

Type of Encounter

Orthopedic physicians need to make specific documentation with a level of specificity which helps coders to understand the patient encounter like an initial one, subsequent encounter, or a sequela encounter.

Orthotics Billing

The entire workflow for orthotics billing involves Rx order entry, patient demographics as well as insurance entry, product code /Rx/Dx entry, checking the eligibility and verification process, collections of the complete Rx, document collection for approval of authorization, claims submission, denial management, constant following up on payment processing as well as A/R.

Now you might have a clear idea about your question but both practices require in-depth knowledge of reimbursement guidelines of Medicare, Medicaid, and Commercial Plans.

If you are looking to outsource your medical billing, we are keeping an eye on every small development in the healthcare of the US and our HIPAA compliant billing experts will help you in your medical billing and coding so that you can get paid timely with no errors.