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…


Going Cosmetic? Part 1

The Association of Dermatology Administrators & Managers Newsletter by Glenn Morley If you’ve decided to make the strategic change toward increasing cosmetic lines of service, you’re joining a bustling movement. Internists, obstetricians, and other specialists continue to enter cosmetic medicine as an antidote to reimbursement decline and the complexities of medical billing and management. The…


Going Cosmetic? Part 2

The Association of Dermatology Administrators & Managers Newsletter by Glenn Morley For physicians who have decided to incorporate cosmetic services into their established dermatology practice, the early planning stages are like a honeymoon. Managers and physicians engage in lively discussion about creating a medical spa or aesthetic center. New skincare lines are road tested by…