Confront Tough Orthopedic Billing & Coding Challenges Before it's Too Late!

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Confront Tough Orthopedic Billing Coding
Challenges Before Its Too Late!
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Agenda

• The MRI Isnt Always Right (slides 4-8)
• BONUS Sneak Peek at 2018 ICD-10-CM Changes for
  Orthopedics (slides 9-13)

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Is your orthopedic practice losing hard-earned
dollars due to incorrect coding and billing?
Weve got you covered!
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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?
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Solution Look to Surgeons Statement,Not MRI
Findings
Use code 29880, which covers everything the
surgeon performed.
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
When coding an operative report, base your
orthopedic diagnosis codes and orthopedic
procedure codes on the operative report, not the
MRI findings.
CPT copyright 2016 American Medical
AssociationAll rights reserved
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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.

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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.

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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.

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BONUS Dont forget to incorporate 2018 ICD-10-CM
changesinto your clean-claim plan!
Do you know which of the 800 changes will impact
orthopedics the most?
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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!

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For Example

• Before Oct. 1
• M48.06
• Spinal stenosis, lumbar region

• Post Oct. 1
• M48.061
• Spinal stenosis, lumbar region without neurogenic
  claudication
• M48.062
• Spinal stenosis, lumbar region with neurogenic
  claudication

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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.

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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 accident, initial
  encounter
• Revised S62.311S, Displaced fracture of base of
  second metacarpal bone, left hand, sequela
• Deleted S63.131A, Subluxation of proximal
  interphalangeal joint of right thumb, initial
  encounter

• Tip Review 2018 changes to ICD-10 codes for
  orthopedics by referring to an updated ICD-10
  manual or online code search tool like Orthopedic
  Coder.

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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

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Let TCI SuperCoder do the update work for
you.Start your free trial of Orthopedic Coder
todaywww.supercoder.com/occ

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

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