Category: Orthopaedics

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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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27095 vs 20610

August 23, 2018 Question: I read with interest your recent Coding Coach on anesthesia related services and CPT codes 27093 and 27095.  If our surgeon performs a hip injection using fluoroscopy should we be reporting 27093 instead of 20610 and 77002-26? We perform these in the ASC. Answer: No, 27093 and 27095 are injection procedures...

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Refresh your Referral Building

Physicians Practice – August 22, 2018 by Karen Zupko Years ago, a “good referral” was described using the Three A’s of medicine: Availability, Affability, and Ability. A physician striving to build a successful practice was advised to deliver all three. Managed care contracts and narrow networks temporarily stifled traditional referral building. But the patient rebellion...

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Bone Marrow Aspirate

August 9, 2018 Question: Our surgeon aspirated bone marrow for a subtalar fusion. We are unsure how to report this. Are you able to help? Answer: Yes, with the guideline changes surrounding CPT code 38220 and the new code 20939, CPT instructs to report 20999 for bone marrow aspirate for other musculoskeletal fusions (non-spine). (For...

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Multiple Fasciotomies Same Hand for Dupuytren’s

July 26, 2018 Question: Our hand surgeon, not infrequently, will perform multiple fasciotomies in the hand for the treatment of Dupuytren’s.  We are reporting CPT code 26045 for each fasciotomy but now we are questioning if this is correct or not.  Before we refund claims paid, will you tell us if this code is reportable...

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Physical Therapy and NPI Numbers

July 12, 2018 Question: We have multiple practice locations and have therapy departments at several of the locations.  Our question has to do with whether or not we should obtain NPI numbers and credential all of the therapists? Answer: KZA recommends that the practice obtain NPI numbers and credential the therapists for “direct billing”, especially...

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NPP Reporting and Claim Form Line 24J

June 28, 2018 Question: How do we know whether to put the NPP (PA or NP) or physician NPI number in box 24J on the claim form? Answer: When services are reported using the Direct billing method, the NPI of the provider performing the services places their NPI number in box 24J.  When services are...

Total Hip Arthroplasty Question
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Total Hip Arthroplasty Question

June 14, 2018 Question: We have a patient who underwent an open fixation of a femoral neck fracture five years ago and now presents for a total hip arthroplasty.   Someone mentioned that we should report a conversion to hip arthroplasty but we are not sure if this is a revision of one component plus a...

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Have You Heard the Latest Professional Liability Risk?

Have You Heard the Latest Professional Liability Risk? AAOS Now- June 2018 By: Michael R. Marks, MD, MBA HIPAA allows states to recognize cause of action for breach of confidentiality The list of liability risks for physicians continues to increase. On behalf of the Medical Liability Committee, this article presents new risks via highlights from...

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