Confront Tough Orthopedic Billing & Coding

Challenges Before Its Too Late!

Agenda
1. The MRI Isnt Always Right (slides 4-8)

2. BONUS: Sneak Peek at 2018 ICD-10-CM

Changes for Orthopedics (slides 9-13)
Is your orthopedic practice losing
hard-earned dollars due to
incorrect coding and billing?

Weve got you covered!

Lets Consider This Orthopedic Medical
Coding Scenario
An orthopedic surgeon states in the
operative report that he did both
medial and lateral arthroscopic
meniscectomies.

All supporting documentation in the chart

states medial and lateral meniscectomies
were performed. But the MRI report refers to
only a medial meniscus tear.

Challenge: Should you report both?

Solution: Look to Surgeons Statement,
Not MRI Findings
Use code 29880,
which covers everything
the surgeon performed.
When coding an operative report,
base your orthopedic diagnosis codes
and orthopedic procedure codes on the
operative report, not the MRI findings.
29880 Code Descriptor: Arthroscopy, knee,
surgical; with meniscectomy (medial AND
lateral, including any meniscal shaving)
including debridement/shaving of articular
cartilage (chondroplasty), same or separate
compartment(s), when performed
CPT copyright 2016 American Medical Association
All rights reserved
Remember

MRIs sometimes show the lateral meniscus as normal even when

further examination via the arthroscopy reveals previously
unseen abnormalities.

To avoid confusion and to support medical necessity, the op

report should address the abnormalities of the lateral meniscus
that warranted the partial lateral meniscectomy.
Reality Check

Everyone makes mistakes, so documentation mistakes by the surgeon

are possible.

If you see red flags that suggest the documentation is inaccurate,

confirm the medical record is correct.
Final Takeaway

Base your coding for the surgery on the operative report, not the MRI.

Query the orthopedic surgeon if he did not include documentation and

postoperative diagnoses that support reporting both medial and lateral
meniscectomies.

Source: Orthopedic Coding Alert, a monthly publication included in Orthopedic Coder.

To learn more about this online solution, visit www.supercoder.com/occ.
BONUS
Dont forget to incorporate 2018 ICD-10-CM changes
into your clean-claim plan!

Do you know which of the 800+ changes will impact orthopedics the most?
For orthopedics, a few minor changes
lead to a whole lot of updates!

Spinal stenosis
Non-pressure ulcers
Phalanx fractures of fingers and toes
ATV accidents
And more!
For Example

Before Oct. 1 Post Oct. 1

M48.06
Spinal stenosis, lumbar region
M48.061
Spinal stenosis, lumbar region
without neurogenic claudication
M48.062
Spinal stenosis, lumbar region
with neurogenic claudication
 More Examples
Phalanx fracture codes for the finger (S26.6-) and toe (S92.5-) will see a
language change from medial phalanx to middle phalanx.
Subluxation and dislocation codes (S63.12-) for thumb interphalangeal
joints will get cleaned up to remove references to proximal and distal.
Non-pressure chronic ulcers (L97.- and L98.-) get additions to help when
coding these:
muscle involvement without evidence of necrosis
bone involvement without evidence of necrosis
other specified severity.
Get a handle on the long list of new, revised,
and deleted codes for orthopedics, including:
New: V86.06XA, Driver of dirt bike or
motor/cross bike injured in traffic Tip: Review 2018 changes to
accident, initial encounter ICD-10 codes for orthopedics
by referring to an updated
Revised: S62.311S, Displaced fracture of ICD-10 manual or online
base of second metacarpal bone, left code search tool like
hand, sequela Orthopedic Coder.

Deleted: S63.131A, Subluxation of

proximal interphalangeal joint of right
thumb, initial encounter
Too much to learn, too little time?

Here are some top resources that need to be up to date

to ensure ICD-10 changes dont cause denials:

ICD-10-CM Code Set

Including Online Coding Software
ICD-10-CM Official Guidelines
CPT to ICD-10-CM Crosswalk
Claim Scrubber
LCDs
Job Aids
 Let TCI SuperCoder do the update work for you.

Start your free trial of Orthopedic Coder today

www.supercoder.com/occ

Orthopedic Coding Alert Lay Terms Crosswalks

Online CPT, HCPCS, and CCI Edits Checker CMS-1500 Scrubber
ICD-10-CM Code Search Medicare Fee Schedules Code Update Analysis
Official Guidelines LCD and NCD Lookup 38 AAPC-Approved CEUs
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