Orthopedic Billing has a very unique set of challenges that requires knowledge of the complex rules utilized by carriers to adjudicate claims. The CPT codes and associated modifiers applied to ensure proper reimbursement are always changing. Continuing education is a must to help ensure accurate and timely payment.

We are experts in medical billing and coding for Orthopedics. Our Orthopedic physician partners trust us to correctly code and bill for procedures such as, arthroscopy, joint injections, spinal surgery and carpal tunnel syndrome.

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Here are two tips for coding and billing common orthopedic procedures.

1.  Keep abreast of coding updates.

The American Medical Association rolls out a number of changes to its Current Procedural Terminology code set each year.

Code 27415 for open osteochondral allograft, knee, open,  is  an existing CPT code, which is newly-added to the Medicare ASC list for 2014 with an average Medicare payment of $2,242,” said Stephanie Ellis, RN, CPC, president of Ellis Medical Consulting, in the report.

2.  Track and avoid common denials.

Here are the five most common unexpected orthopedics claim denials that occurred from Oct. 19, 2013 to Jan. 16, 2014, according to RemitDATA :

  • CPT code 99213: Outpatient doctor visit, level 3
  • CPT code 20610: Aspiration and/or injections; major joint or bursa

The top reason codes for these unexpected denials include:

  • 45: Charge exceeds fee schedule
  • 23: Prior payer(s) adjudication affected this payment and/or adjustment