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ED Treatment of Fracture by Advanced Practice Provider
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ED Treatment of Fracture by Advanced Practice Provider

November 29, 2018 Question: Our physicians are asking us to report closed treatment without manipulation codes when their Advanced-Practice Provider evaluates a patient with a fracture in the ED, in preparation for definitive care to be done in the operating room the following day.  What services should be coded for the services rendered by the...

Fracture Treatment and Teaching Physician Requirements
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Fracture Treatment and Teaching Physician Requirements

November 15, 2018 Question: Our physicians teach residents in an academic medical center.  Often the residents see fracture patients in the ED and reduce fractures without the attending physician present.  When the patients follow up with the teaching physicians in the office, they want us to report the global fracture codes that say “without manipulation”,...

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CPT Code 20610 or 20611?

November 1, 2018 Question: Our physician performed a shoulder joint injection with ultrasound guidance.  The physician’s procedure note does not fully detail the ultrasound guidance, other than the ultrasound was used to do the injection. The physician does not document that images were saved (and we can’t find images).  The physician also does not have...

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New patient or not?

October 18, 2018 Question: One of our providers serves as a team physician for a local high school. I was wondering how to report services if he sees an athlete on the sideline for an injury and then the athlete is seen later for the same or a new problem by him or another member...

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CERT Reviews for Arthroscopic Rotator Cuff Repairs

October 4, 2018 Question: We recently heard about Medicare doing CERT reviews for CPT code 29827 (arthroscopic rotator cuff repair).   We are not sure this is true and are wondering how we might find out more information? Answer: The information you heard is correct.  We cannot address Medicare’s Scope of CERT reviews but are aware this...

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Answers to Five Common Coding Questions

Answers to Five Common Coding Questions AAOS Now – October 2018 by Margaret M. Maley, BSN, MS and Sarah Wiskerchen What orthopaedic surgeons, practice managers, and staff want to know In this article, we discuss five concerns from surgeons and their staff that are currently “trending.” 1. Vendor advice = a flashing yellow light Question: Our orthopaedic...

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Viscosupplementation Injections

September 20, 2018 Question: There is a lot of confusion in our office when the doctor injects viscosupplementation and it is not covered by a plan. The physicians want to report 20610 to the payor for the injection and have the patient self pay for the drug.  Our billers do not believe this practice is...

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Modifier 56

September 6, 2018 Question: Why would we receive a Medicare denial when reporting a major surgical procedure with a modifier 56? We only did the pre-procedure work and made the decision for surgery. Answer: Medicare does not recognize modifier 56 (pre-operative care only); instead report the E&M for the decision for surgery.  Append modifier 57 if...

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Reasons Why Diagnostic Coding Matters in Value-based Care

Reasons Why Diagnostic Coding Matters in Value-based Care AAOS Now – September 2018 by Margaret M. Maley, BSN, MS Payers are great at collecting data. They use the information to develop payment policies, determine reimbursement rates, and, increasingly, to negotiate value-based contracts. Payers profit because they know how much it costs to take care of...

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