September 19, 2019 Question: Our surgeons are harvesting adipose tissue and creating an injectable implant that they are injecting in the knee for treatment of osteoarthritis. We want to verify that our use of an unlisted CPT code is correct. We have some payors who do reimburse for this service; others require the patient to...
September 5, 2019 Question: Our local hospital employs Physician Assistants. When our doctors are on call for the ED, the hospital-employed PA will call our doctor for their opinion and advice after seeing and evaluating the patient. At times our physician will go to the ED, see the patient and perform surgery. The question my...
Practice Acquisition: How to be Easy to Do Business With Healio Orthopedics – August 2019 by Karen Zupko When was the last time you ran your referral report? If you are contemplating a merger or acquisition, your referral report is a valuable asset. If you’d prefer to stay independent, it may be one of the...
August 22, 2019 Question: A patient presents to the office who meets Medicare’s definition for medical necessity for routine foot care. Nails are noted to be elongated and thickened, and hyperkeratotic lesions are noted to be on the right plantar heel and right foot second metatarsal head. The podiatrist debrides all ten nails and trims...
August 8, 2019 Question: Our physicians utilize residents during surgery but we have a discrepancy in what is considered a “Qualified Resident”. Some physicians consider a resident qualified to assist day 1 of their residency rotation, while others consider only 4th and 5th year residents as qualified to assist. Can you guide us to documentation...
July 25, 2019 Question: Our surgeon performed a meniscectomy on a Medicare beneficiary. During the 2nd post-operative visit the surgeon started a series of Hyaluronate injections in the operative knee for a diagnosis of osteoarthritis. The claim form was submitted with a modifier 79 and a diagnosis of osteoarthritis. Our Medicare carrier denied it as...
July 11, 2019 Question: What CPT codes do I use for comparison when the surgeon performs a superior capsular reconstruction? I know I have to use an unlisted code. Answer: Great job in knowing that this procedure is reported with an unlisted code. The AAOS recommends comparing this procedure to CPT codes 29827 and 29806. ...
Tips and Best Practices for Using Code-X AAOS Now – June 2019 by Cheryl Toth After speaking with Michael Marks, MD, MBA, and Margaret Maley, BSN, senior consultants from KarenZupko & Associates, Inc., (KZA) about the most valuable features of Code-X in part one, Cheryl Toth, MBA, spoke with Madelaine Reese, senior product manager of online learning...
Coding Experts Weigh in on the Value of Code-X AAOS Now – May 2019 by Cheryl Toth If you are looking for an electronic tool that makes code selection easier and gives your practice powerful data for reducing denials, strengthening appeals, and validating plan payments, the Academy’s Code-X software tool is a good choice. Code-X is a...
June 20, 2019 Question: I perform an arthroscopic repair of the supraspinatus and subscapularis tendons through separate incisions/portals. May I report CPT code 29827 twice? Answer: CPT code 29827, arthroscopic rotator cuff repair is reported one time regardless of whether one or all four tendons are repaired. Consider adding modifier 22 for the additional complexity...
