November 12, 2020 Question: I heard that the E/M code guidelines are changing in 2021. Will this apply to all E/M codes? Answer: Good question. The 2021 changes will NOT apply to all E/M codes. The 2021 changes apply only to the new patient, 9920x, and established patient, 9921x, categories of codes. That means you...
October 29, 2020 Question: My physician performed an SI joint injection in the ASC under ultrasound guidance and wants to bill 27096 and 76942. Is this correct? The description of the codes say imaging is included. Answer: No, this is not correct; you are correct to catch the inclusion of the imaging statement. CPT code...
October 15, 2020 Question: Our surgeon frequently documents in the procedure title that an arthroscopic subacromial decompression was performed. We are billing 29826 and are receiving denials from one particular payor stating that the documentation does not support the service. I am looking at the operative notes associated with these denials and see that in...
October 1, 2020 Question: We have a patient who had knee surgery and required a return to the operating suite for treatment of a complication during the global period. We will bill the second surgery with a modifier 78. My supervisor is saying the aftercare needs to be extended another 90 days because the surgeon...
September 17, 2020 Question: Our physicians are looking at purchasing generic Hyaluronan instead of purchasing the name brand Orthovisc or MonoVisc for example. In doing research, I am not finding any NDC codes or HCPCS codes that specifically address the generic Hyaluronan. I also came across this list of Hyaluronic Acid Derivatives. If I am...
September 3, 2020 Question: Which CPT code is used 20550 or 20551 for a trigger finger /A1 pulley injection? Answer: CPT code 20550 defines an injection to a single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”). CPT code 20551 defines an injection to single tendon at the origin/insertion site. Trigger finger injections are most...
August 6, 2020 Question: I am new in orthopaedics and am reviewing an operative note. The patient had a total knee arthroplasty five years prior to this surgery. The patient presented with patellofemoral knee pain and was taken to the OR for a chondroplasty and partial synovectomy were performed. The post-operative diagnosis, other than S/P...
July 23, 2020 Question: I work with a sports surgeon and we see just a few Medicare patients. The surgeon believes the revised 2021 E/M guidelines will not impact our office practice because of our low Medicare volume. Is this correct? Answer: This is not correct, but it is a common misconception. The revised documentation...
July 9, 2020 Question: I’m a pediatric orthopedic surgeon. Some of my team are reporting the NPWT codes 97605 and 97606 when applying wound vacs after closing at the completion of their surgical cases. As a result, I am told by my coders that NCCI Standards of Medical Practice edits are being generated. The NCCI guidelines define the...
June 25, 2020 Question: I am a pediatric orthopaedic surgeon and many of my patients are too young to give a history. My coders have never given me medical decision making (MDM) credit because they say it is part of dealing with children. Is there anything in the 2021 CPT guidelines for outpatient E/M services...
