Problems like injuries, congenital deformities or abnormalities, and diseases concerning the musculoskeletal system fall under the purview of orthopedic treatments. Regardless of the nature of orthopedic specialization your clinic excels at successful billing practices demand that your medical billing specialist is well versed in fulfilling the coding demands relative to the specialty field.
The correct interpretation of information and proper application of codes, modifiers, and extensions facilitates the creation and flawless functioning of a proper revenue stream for the practice by minimizing claim rejections and denials. Following the guidelines put forth by CMS (Centers for Medicare and Medicaid Services), our orthopedic specialist coders provide billing services that pump up your revenue cycle.
The implementation of ICD-10 brought around with it 264 new codes, 143 deleted, and 134 revised codes that apply to coding for an orthopedic practice. New rules related to modifier 59 and the introduction of the applicable modifiers XU, XE, XP, and XS are here to revolutionize orthopedics billing from here. Our team of skilled medical billing professionals displays their understanding of the ICD-10 and proficiency in numerous ways in which the new requirements and coding changes impact orthopedics.
What Are Modifiers & Why Are They Game Changers in orthopedics billing?
By definition, Modifiers are simple two-character designators that signal towards a change in how the code for the procedure or services should be applied for the claim. If put to use strategically, modifiers add to the accuracy and detail to the record of the medical encounter. If misused, they can lead to claim denials, payer audits, and in rare cases investigations, refunds, and fines.
Modifiers are two-digit codes and are categorized into two levels:
- Level I Modifiers: Normally known as CPT Modifiers and consists of two numeric digits and is updated annually by AMA – American Medical Association. These CPT modifiers are used to additionally supplement the information or adjust care descriptions to provide extra details concerning a procedure or service provided to a patient.
- Level II Modifiers: Also known as HCPCS Modifiers and these consist of two digits (Alpha / Alphanumeric characters) in the sequence AA through VP. These modifiers are annually updated by CMS – Centers for Medicare and Medicaid Services.
Obtaining the rightful revenue through your orthopedic requires detailed knowledge and the use of code modifiers wherever suitable and permissible. Modifiers are added to the main procedure code to indicate that the procedure has been altered by a distinct factor. Modifiers can increase or decrease reimbursement. They can also cause claims not to play properly or deny if used incorrectly or not used, when necessary. Some modifiers are for use by Ambulatory Surgical Centers only, some for physician practices, and some are for use by both provider types.
Here is a concise table representing the use of modifiers in orthopedic services:
|-58||Staged or related procedure or service by the same physician during the postoperative period||Both||Use this modifier to indicate the performance of a procedure or service during the postoperative period that was:
2. More extensive than the original procedure.
3. For therapy following a diagnostic surgical procedure.
|-59||Distinct procedural service||Both||
|-73||Discontinued outpatient hospital/ASC procedure prior to the administration of anesthesia||(A)||
|-74||Discontinued outpatient hospital/ASC procedure after the administration of anesthesia||(A)||
|-76||Repeat procedure or service by the same physician||Both||
|-77||Repeat procedure or service by another physician||Both||
|-78||Return to the OR for a related procedure during the postoperative period||Both||
|-79||Unrelated procedure or service by the same physician during the postoperative period||Both||
|-RT & -LT||Right Side and Left Side||Both||
|Left hand, thumb
Left hand, second digit
Left hand, third digit
Left hand, fourth digit
Left hand, fifth digit
Left foot, the great toe
Left foot, second digit
Left foot, third digit
Left foot, fourth digit
Left foot, fifth digit
|Right hand, thumb
Right hand, second digit
Right hand, third digit
Right hand, fourth digit
Right hand, fifth digit
Right foot, the great toe
Right foot, the second toe
Right foot, third digit
Right foot, fourth digit
Right foot, fifth digit
|-SG||ASC facility service||(A)|
|-GA||Waiver of liability on file||Both|