How to Overcome 4 Top Orthopedic Coding Challenges

Wed, Jan 24, 2018 --

Skill Sharpener

As an orthopedic coder, you face numerous challenges ranging from coding for common fractures to taking stock of bundling issues. Here are some handy tips to help you and your practice overcome four common orthopedic challenges and stay on track to deserved reimbursement this year.

1. Cast Away Your Fracture Care Coding Confusion
Orthopedic coders deal with fracture care patients often — and reporting inaccurate codes when related to fractures and their types can lead to revenue loss or claim denials. That’s why you must stay sharp when it comes to fracture care coding, and know the intricacies involving terminology.

You need to know the difference between an open and closed fracture. You also may need to determine if the physician performed manipulation before selecting a fracture care code — so make sure you study up on which kinds of fractures require physician manipulation. For example, fractures that require manipulation include angulated, displaced, and dislocated. So next time you find any of these terms on the encounter form, keep an eye out for evidence of manipulation.

2. Know the Updated Descriptor for Observation Services
Reporting your providers’ observation services can be complicated if you are not careful. With two sets of codes to choose from, which codes you use may depend on payer, length of stay, and many other factors that can make it tough to find the right code.

Moreover, CPT® 2018 has an update to one set of observation codes. If you report hospital observation codes 99217 and 99218-99220, don’t overlook this E/M verbiage change effective Jan. 1 — all of the descriptors add the phrase “outpatient hospital” in the phrase “outpatient hospital ‘observation status.’”

3. Perfect Your Trigger Point Injection Claims

Patients in pain frequently require trigger point injections (TPIs) for their conditions. Even though these services are reported with only two TPI codes, it does not necessarily mean reporting diagnosis codes for TPIs is simple.
For one thing, the covered/noncovered, diagnoses for TPIs will vary by location, payer, and, on many occasions, encounter specifics. Moreover, many payers have limited payment policies for trigger point injections. So make sure you check the policies that apply to your claims.

Also be sure to work with providers to help match documentation to code requirements. For instance, they may need to go beyond the pain’s location and explain what caused the pain.

4. Know Anatomy & Totality of Arthroplasty for Accurate Coding

To code a knee arthroplasty properly, you need to be aware of the anatomy and extent of the arthroplasty. While some arthroplasties are complete, some only address some parts of the knee. Some of the common questions you may face while reporting knee arthroplasty procedures include:

  • Is this a standard total knee replacement?
  • Does the case involve both the femoral and tibial components?
  • Does documentation meet payer policy and medical necessity requirements?

Tip: Need detailed answers to these questions along with step-by-step expert orthopedic coding advice? Check out Orthopedic Coding Alert today!

How About You?
What orthopedic challenges do you need help with in 2018?


Barnali is a medical coding and billing writer at TCI who has worked in the healthcare industry since 2009. She holds a master’s degree in English literature and a diploma in advertising and marketing. She enjoys writing about ICD-10 and Medicare compliance.

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