"Orthopedics" Articles

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December 22nd, 2020

ICD-10-CM 2021 Codes for your Specialty

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020

13. Diseases of the musculoskeletal system and connective tissue (M00-M99) Code: Description:M05.7A Rheumatoid arthritis with rheumatoid factor of other specified site without organ or systems involvementM05.8A Other rheumatoid arthritis with rheumatoid factor of other specified siteM06.0A ...

December 22nd, 2020

ICD-10-CM 2021 Codes for your Specialty

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020

18. Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Code: Description:R51.0 Headache with orthostatic component, not elsewhere classifiedR51.9 Headache, unspecifiedR74.01 Elevation of levels of liver transaminase levelsR74.02 ...

December 22nd, 2020

ICD-10-CM 2021 Codes for your Specialty

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 22nd, 2020

20. External causes of morbidity (V00-Y99) Code: Description:V00.031A Pedestrian on foot injured in collision with rider of standing electric scooter, initial encounterV00.031D Pedestrian on foot injured in collision with rider of standing electric scooter, subsequent encounterV00.031S Pedestrian on foot injured ...

December 8th, 2020

Common Medical to Dental Procedures and Where to Find Them

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 8th, 2020

With healthcare integrating and consolidating the delivery of healthcare systems, it only makes sense using medical insurance affords better management of care, dental providers are quickly picking up the slack on dental policies and utilizing healthcare coverage, understanding this affords better care for their patients. There are many common dental procedures that ...

October 28th, 2020

Incident To

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 28th, 2020

Just about any large clinic you visit will have non-physician practitioners, or NPPs. These will include physician assistants, nurse practitioners, and clinical nurses for example. Practices and clinics can bill under the NPPs if they are credentialed with the payer, but the reimbursement is only 85% of the fee schedule. There ...

August 10th, 2020

Coding Injections for Pain Management

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 10th, 2020

Coding for pain management can get confusing. How many injections, the location, and when to use a modifier are all common questions. This article will cover some of the most common injections used in pain management. Trigger Point Injections Trigger point injections are reported by how many muscles are treated using an ...

August 10th, 2020

Modifier 50 — Four "Must Know" Tips For Getting Paid

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published August 10th, 2020

Modifiers added to an HCPCS or CPT© code alters the code description, providing clarity about the service for proper claim processing and reimbursement. Here are four things you must know about modifier 50 to ensure proper payment. - Modifiers are either informational or payment related. Informational modifiers provide additional...

July 14th, 2020

Are NCCI Edits and Modifiers Just for Medicare?

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 14th, 2020

The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...

February 10th, 2020

A 2020 Radiology Coding Change You Need To Know

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 10th, 2020

The radiology section of the 2020 CPT© has 1 new, 18 revised, and 14 deleted codes. Interestingly, six of the 14 deleted codes were specific to reporting single-photon computerized tomographic (SPECT) imaging services of the brain, heart, liver, bladder, and others. If your organization reports radiology services, it is...

January 30th, 2020

Medicare Announces Coverage of Acupuncture Services

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 30th, 2020

On January 21, 2020, a CMS Newsroom press-release read, This new announcement is both exciting and refreshing. Acupuncture, a key component of traditional Chinese medicine and most commonly used to treat pain, is now being officially recognized by Medicare and several other large payers as a covered, alternative treatment option for ...

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October 1st, 2019

Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019

Atrial fibrillation (AF) is the most common type of abnormal heart rhythm (arrhythmia). It is caused by a disorder in the heart’s electrical system. AF is the result of abnormal contractions of the atria (upper two chambers of the heart) causing them to quiver and beat out of sync with ...

August 16th, 2019

Medical ID Theft

By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019

Medical ID Theft "So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...

August 9th, 2019

The OIG Work Plan: What Is It and Why Should I Care?

By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019

The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...

July 12th, 2019

5 Ways to Minimize HIPAA Liabilities

By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019

Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability. Take ...

June 18th, 2019

How to Properly Report Monitoring Patients Taking Blood-thinning Medications

By Wyn Staheli, Director of Research | Published June 18th, 2019 - Last Review/Update June 19th, 2019

Codes 93792 and 93792, which were added effective January 1, 2019, have specific guidelines that need to be followed. This article provides some guidance and tips on properly reporting these services.

May 21st, 2019

RT and LT Modifier Usage Change (effective 2019-03-01)

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 21st, 2019

According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...

May 6th, 2019

Q/A: If Orthopedic Tests are Negative, do You List Them in Your Treatment Notes?

By Wyn Staheli, Director of Research | Published May 6th, 2019

Question: If orthopedic tests are negative, do you need to still list them in your treatment notes? Answer: Yes. Any tests which are performed by a healthcare provider, regardless of the result, should be documented in the patient record. This record is the only way that a reviewer or another provider ...

March 18th, 2019

How to Report Imaging (X-Rays) of the Thumb

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 18th, 2019

If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...

January 4th, 2019

Nine New Codes for Fine Needle Aspirations (FNA) in 2019

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 4th, 2019

If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ...

October 17th, 2018

Wolters Kluwer Drug Pricing

By Find-A-Code | Published October 17th, 2018

Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...

August 10th, 2018

Q/A: How Do I Release a Patient from PI When They Still Have Problems?

By Wyn Staheli, Director of Research | Published August 10th, 2018 - Last Review/Update January 28th, 2019

Once a PI patient is released with symptoms, or without symptoms, and a prognosis of likely exacerbations with a future medical estimation of $1500 over then next 2 years, how am I supposed to release them from care when they still have ongoing needs? We have discussed this with several different experts. The consensus is....

July 9th, 2018

Documentation: Face to Face for Home Health Certification

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018

As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care. Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ...

May 30th, 2018

Coding for Strains in ICD 10

By BC Advantage | Published May 30th, 2018 - Last Review/Update June 4th, 2018

According to the National Institutes of Health, a review was carried out on 20 patients who had a pectoralis major muscle repair between 2003 and 2011, and the results were as follows....

May 14th, 2018

TKAs to Outpatient What We Have Learned with Q1

By Shannon Cameron, MBA, MHIIM, CPC | Published May 14th, 2018 - Last Review/Update May 24th, 2018

The release of the 2018 Final Rule for the Outpatient Prospective Payment System (OPPS) in November 2017 has created quite a stir across the orthopedic healthcare community. In what has been deemed a questionable decision, the Centers for Medicare and Medicaid Services (CMS) decided to remove Total Knee Arthroplasty...

March 8th, 2018

Documentation for Manual Wheelchairs

By Medicare Learning Network | Published March 8th, 2018 - Last Review/Update March 15th, 2018

The Medicare Learning network provides guidance on how to prevent denials for Manual Wheelchair Bases....

February 1st, 2018

Diagnosis Codes Used With : Vertebroplasty, Vertebral Augmentation and Computed Tomography

By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 1st, 2018

Per CGS Administrators LCD L34048 the following codes are the ICD-10-CM Cdes that support Medical Necessity: (Be sure to verify with your local payer) Stand Alone ICD-10 codes M80.08XA M80.88XA M80.88XG Primary Diagnosis Codes M48.51XA M48.52XA M48.53XA M48.54XA M48.55XA M48.56XA M48.57XA M48.58XA M84.68XA Secondary Diagnosis Codes One of the following diagnosis codes must be reported with one of the codes above in group 2.Combination coding of the primary diagnosis(group 2) of pathologic fracture ...

January 9th, 2018

Should ROM Testing be Reported with Evaluation and Management Services?

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 9th, 2018

Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.

December 26th, 2017

CMS Finalizes Comprehensive Care for Joint Replacement Model Changes, Cancels Episode Payment Models & Cardiac Rehabilitation Incentive Payment Model

By Find-A-Code | Published December 26th, 2017

According to CMS: On November 30, CMS finalized the cancellation of the mandatory hip fracture and cardiac bundled payment models that were to be operated by the CMS Innovation Center and implemented changes to the Comprehensive Care for Joint Replacement (CJR) Model. These changes will offer greater flexibility and choice for ...

December 18th, 2017

Accreditation and Billing for Office Based Surgery (OBS)

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 18th, 2017

The traditional healthcare has seen many changes over the years, one of the newest changes we are seeing is procedures once being done as an inpatient, then as an outpatient and now from the outpatient facility to Office-Based procedures. For an Office or Provider to be eligible to perform Office-Based Surgery the ...

December 12th, 2017

Documenting the Location and Correct Coding

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 12th, 2017

The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim. You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas). C1 is the first vertebra known as the atlas. The axis-form is ...

February 27th, 2017

Documentation: Face to Face for Home Health Certification

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 27th, 2017 - Last Review/Update August 16th, 2017

March 7th, 2016

Diagnosis Codes for Cervical Kyphosis

By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published March 7th, 2016

Coding for a reduced cervical curve is a little tricky in ICD-10. This article explores the choices and issues around this diagnosis.

February 1st, 2016

Documentation and Billing Practices

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 1st, 2016 - Last Review/Update August 7th, 2017

Prescribed to: Reduce pain by restricting mobility of the trunk: OR Facilitate healing following an injury to the spine or related tissue; OR Otherwise support weak and/or deformed spinal muscles. Documentation and billing practices be sure you are meeting all the requirements to bill a spinal orthoses. Spinal Orthoses billed with HPCPCS L0450, L0454, L0621, L0625 and L0628 must be billed with ...

January 29th, 2016

Wound Care & Debridement- Provided by Physician, NPP or as Incident-to Services

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2016

Providers must document the medical necessity for all services provided. If there is no documented evidence (e.g., objective measurements) of ongoing significant benefit, then the medical record documentation must provide other clear evidence of medical necessity for treatments. The medical record must also clearly indicate the complexity of skills required ...

November 20th, 2015

Documentation of Pressure Ulcers

By Find-A-Code | Published November 20th, 2015

Documentation of Pressure Ulcers, read entire article by Wound Consultants Inc. ...

October 20th, 2015

Finding Strain and Sprains in ICD-10-CM

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 20th, 2015

There has been some confusion on Sprain vs. Strain and how to find them in ICD-10-CM. They are now split in two separate code ranges and Injury is now related to the anatomic location specific to the injury. It will help to remember the following information when searching for Strains vs. ...

August 17th, 2015

Fracture Documentation for ICD–10

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 17th, 2015

Documentation requirements for fractures have a lot of components that must be addressed in ICD-10-CM and many gaps that need to be filled in to document and code correctly. Is it Traumatic or Pathologic? Which bone, location and laterality, which encounter? Don't forget: an encounter is not a visit. Classification, alignment and fracture ...

May 11th, 2015

How To Report Co-Surgeons and Assistant Surgeon Modifiers

By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 11th, 2015 - Last Review/Update January 30th, 2017

Some surgeries require the expertise of more than one surgeon or may require the assistance of another surgeon to ensure adequate care is given and the surgery is a success. Let's review a couple terms: Co-Surgeon: When two surgeons act as primary surgeon for a specific procedure. Each acts as the primary surgeon ...

December 4th, 2014

Correct Coding: Braces (Orthoses) Attached to Wheelchairs

By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published December 4th, 2014 - Last Review/Update August 9th, 2017

Joint DME MAC and PDAC Publication Recently, claims for braces attached to wheelchairs have been submitted using HCPCS code K0108 - WHEELCHAIR COMPONENT OR ACCESSORY, NOT OTHERWISE SPECIFIED. K0108 is not the correct HCPCS code to use for these items. CMS has clarified the distinction between braces (orthoses) and durable medical equipment (DME) under Medicare Part ...

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"Orthopedics" Articles

ICD-10-CM 2021 Codes for your Specialty

ICD-10-CM 2021 Codes for your Specialty

ICD-10-CM 2021 Codes for your Specialty

Common Medical to Dental Procedures and Where to Find Them

Incident To

Coding Injections for Pain Management

Modifier 50 — Four "Must Know" Tips For Getting Paid

Are NCCI Edits and Modifiers Just for Medicare?

A 2020 Radiology Coding Change You Need To Know

Medicare Announces Coverage of Acupuncture Services

Do ICD-10 Updates Have Your Heart Beating Irregularly? Check Out the New Atrial Fibrillation Codes

Medical ID Theft

The OIG Work Plan: What Is It and Why Should I Care?

5 Ways to Minimize HIPAA Liabilities

How to Properly Report Monitoring Patients Taking Blood-thinning Medications

RT and LT Modifier Usage Change (effective 2019-03-01)

Q/A: If Orthopedic Tests are Negative, do You List Them in Your Treatment Notes?

How to Report Imaging (X-Rays) of the Thumb

Nine New Codes for Fine Needle Aspirations (FNA) in 2019

Wolters Kluwer Drug Pricing

Q/A: How Do I Release a Patient from PI When They Still Have Problems?

Documentation: Face to Face for Home Health Certification

Coding for Strains in ICD 10

TKAs to Outpatient What We Have Learned with Q1

Documentation for Manual Wheelchairs

Diagnosis Codes Used With : Vertebroplasty, Vertebral Augmentation and Computed Tomography

Should ROM Testing be Reported with Evaluation and Management Services?

CMS Finalizes Comprehensive Care for Joint Replacement Model Changes, Cancels Episode Payment Models & Cardiac Rehabilitation Incentive Payment Model

Accreditation and Billing for Office Based Surgery (OBS)

Documenting the Location and Correct Coding

Documentation: Face to Face for Home Health Certification

Diagnosis Codes for Cervical Kyphosis

Documentation and Billing Practices

Wound Care & Debridement- Provided by Physician, NPP or as Incident-to Services

Documentation of Pressure Ulcers

Finding Strain and Sprains in ICD-10-CM

Fracture Documentation for ICD–10

How To Report Co-Surgeons and Assistant Surgeon Modifiers

Correct Coding: Braces (Orthoses) Attached to Wheelchairs

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