Are CMS and Other Payers Requiring –X{EPSU} Modifiers?

Commonly Asked Coding Questions – September 2016 by Sarah Wiskerchen, MBA, CPC  Q: Are the Centers for Medicare & Medicaid Services (CMS) and other payers requiring use of –X{EPSU} modifiers? A: Although the four –X{EPSU} modifiers were initiated by CMS, they have also been part of the Common Procedural Terminology (CPT) manual since 2015. These four…


Liability Management 101

Liability Management 101 – August 2016 by Michael R. Marks, MD, MBA Why Malpractice Insurance Is Not Enough Today’s orthopaedic practices are at a crossroads. Many face possible mergers or acquisitions and potential relationships with hospital systems and third-party payers. As the healthcare landscape shifts, so too does a practice’s professional liability exposures. Recently, I spoke…


Spine Surgery Quandary: Posterior Lumbar Interbody Fusion

Healthcare Business Monthly – June 2016 by Kim Pollock, RN, MBA, CPC, CMDP When do you bill 63056-59 with 22633, rather than 63047-59? A common question among coders and spine surgeons is whether to bill 63056-59 with 22633, or 63047-59. The answer is complex, but CPT® and Medicare guidelines provide essential guidance. Read Full Article


PA and NP Billing: Are You Doing It Correctly?

PA and NP Billing: Are You Doing It Correctly? – May 2016 by Sarah Wiskerchen, MBA, CPC  The effective use of physician assistants (PAs) and nurse practitioner (NPs) in an orthopaedic practice requires an understanding of key billing rules that apply to these nonphysician providers (NPPs). Compare your practice’s internal procedures to the following common questions…


Minor Procedure at the Time of Service Language

Explanation of billing when performing a minor surgical procedure in the office, e.g. fiberoptic flexible laryngoscopy, nasal endoscopy. This letter could be given to patients to explain that the AMA CPT coding rules requires the physician to report a CPT code that is defined by the payor and the AMA as a “surgical” procedure. Download…


“Clean Up” Diagnosis Coding for Staged Revisions

“Clean Up” Diagnosis Coding for Staged Revisions – July 2015 by Margaret M. Maley, BSN, MS Assigning diagnosis codes for joint revision surgery is challenging in both ICD-9-CM and ICD-10-CM. Orthopaedic practices that carefully examine the instructions in both editions may find that they have been reporting staged revisions incorrectly for years. The following side-by-side comparison…


Clean Up Your Revenue Cycle Now: 6 Survival Tips for ICD­10 ­Induced Payment Slowdowns

The American Journal of Orthopedics – May 2014 by Cheryl Toth, MBA You have read the scary headlines and dire predictions about ICD-10 claim submission complications and cash-flow crunches. What are you doing to avoid a near-certain slowdown in your revenue cycle this fall? Assessing and improving specific areas of the revenue cycle cannot only…


Mapping Your Way to ICD-10 Implementation Success

AAOS Now – December 2014 by Sarah Wiskerchen, MBA, CPC As orthopaedic surgeons and their practice teams ready themselves for the implementation of ICD-10, a team-based transition action plan is essential. One step in making the transition is known as “mapping.” Mapping describes the process of comparing the codes currently used in ICD-9 to those…


6 Action Steps for Getting Documentation Ready for ICD-10

Doctors Direct Insurance Newsletter – Winter 2014 by Cheryl Toth, MBA We are less than a year away from the biggest change to healthcare administration in decades. Yet, many practices are woefully behind when it comes to their ICD-10 conversion planning. And some physicians still mistakenly believe that this is a job for their billing staff….


When “7” Is Not a Lucky Number

When “7” Is Not a Lucky Number – November 2014 by Margaret M. Maley, BSN, MS Using the 7th character extension in ICD-10-CM for orthopaedic injuries The 7th character extension represents a major distinction between the International Classification of Diseases, Ninth Edition (ICD-9) and the International Classification of Diseases, Tenth Edition (ICD-10). A clear understanding of…


Do Your E/M Service Levels Match Medical Necessity?

KZA Practice Brief for Orthopedics – September 2014 by Cheryl Toth, MBA In May of this year, the Office of the Inspector General (OIG) published a report describing, among other things, its methodology for evaluating E/M code documentation during audits for the Centers for Medicare and Medicaid Services (CMS). In addition to the OIG’s typical…


ICD-10 Focus on Common Knee and Shoulder Codes

ICD-10 Focus on Common Knee and Shoulder Codes – August 2014 by Margaret M. Maley, BSN, MS Much has been written about the explosion of diagnosis codes under the International Classification of Diseases, 10th Edition Clinical Modifications (ICD-10). The amplified granularity of the system and the addition of laterality coding will certainly have an impact on orthopaedics….


Avoid Billing Service Nightmares: Issues to consider before partnering with independent and hospital-based billing services

AAOS Now – April 2014 by Jennifer A. O’Brien, MSOD In addition to the compliance and security issues highlighted in part 1 of this series (“Avoid Billing Service Nightmares,” AAOS Now, February 2014), an evaluation of operations, experience, and costs is essential to selecting the right partner for the provision of billing services. This is…


Are Online Coding Discussions Putting Your Practice At Risk?

Medical Office Manager – April 2014 by Cheryl Toth, MBA Here’s an email we recently saw while monitoring a specialty coding listserv: We have a surgeon that says I am not an aggressive coder because I communicate to him when NCCI indicates that certain procedures are bundled, and now I am second-guessing myself. Can you…


Four Things to Know About ICD-10 and Prior Authorization

Physicians Practice – March 26, 2014 by Cheryl Toth, MBA When most practices think about the shift from ICD-9 to ICD-10, they think of changes to physician documentation, diagnosis code selection, and software upgrades. But ICD-10 is going to have a big impact on the pre-authorization process too. Here’s why, and what to do about…


How Do YouSpell ICD-10 Success? Teamwork Pays Off For a Nebraska Practice

AAOS Now – March 2014 by Cheryl Toth, MBA New West Sports Medicine & Orthopaedic Surgery, Kearney, Neb., is a seven-surgeon practice with seven physician assistants (PAs) and four athletic trainers (ATs). It’s also ready to face the challenges presented by the transition to the International Classification of Diseases, 10th edition (ICD-10) in October. The…


Coding Boards or Confessionals? Use Online Coding Discussion Tools With Caution

The American Journal of Orthopedics – March 2014 by Cheryl Toth, MBA Author’s Note: The content of the e-mail examples presented in this article is from actual online discussions. Practice and participant names and contact information have been changed. Thanks to Arlene’s question, posted to an orthopedic listserv group, Surgical Specialists has just sent an…


Avoid Billing Service Nightmares: Use Business Rigor to Reduce Your Risk: Part I

AAOS Now – February 2014 by Cheryl L. Toth, MBA Recently, an orthopaedic surgeon remarked that he was thinking about outsourcing his billing so he could avoid learning ICD-10 and make ICD-10 “the billing service’s problem.” But hastily outsourcing billing and collections without carefully evaluating the company can lead to problems. Choosing the wrong billing…


Ready, Set, 10 Months to Go: How to Get Organized and Be Fearless About ICD-10

The American Journal of Orthopedics – December 2013 by Cheryl Toth, MBA “The billing office is handling that,” an orthopedic surgeon at a recent reimbursement workshop said. Like many physicians, he was unaware that asking the billing office to handle ICD-10, the 10th revision of the International Statistical Classification of Diseases and Related Health Problems…


Ferocious Fracture Documentation for ICD–10

Ferocious Fracture Documentation for ICD–10 – November 2013 by Margaret M. Maley, BSN, MS With less than 1 year to go before implementation of the International Classification of Diseases, 10th revision (ICD–10), the American Health Information Management Association (AHIMA) suggests that practitioners focus on their documentation to identify gaps that need filling before the “go live”…