2019 Advanced Specialty Coding: Ready for 2021 E/M? Worker’s comp may not be, and 6 other tips

Why This Topic Matters

The article helps practices anticipate payer differences, strengthen documentation, and stay aligned with evolving coding guidance that can affect claim submission, denials, and compliance.

Article Sections

1. E/M documentation changes and workers’ compensation adoption

   Overview of the upcoming office-outpatient E/M documentation update and the need to check payer implementation timing. The section places the discussion in the context of workers’ compensation and other payer types.

2. Modifier and add-on code guidance

   Discussion of a change in modifier usage for add-on reporting and related payer considerations. The section also notes potential effects on frequency edits and claim processing.

3. Organizing operative notes for multiple procedures

   Tips for structuring operative documentation so that separately billable services are clearly supported in the record. The focus is on documentation clarity for coders, payers, and auditors.

4. Shoulder arthroscopy denial issues

   Discussion of payer denial patterns involving shoulder arthroscopy services and the documentation themes used to support appeals. The section addresses common documentation expectations from a specialty benefit management company.

5. Repair versus reconstruction

   Explanation of how the article distinguishes routine repair from more extensive reconstruction concepts in musculoskeletal coding. The section uses procedure examples to illustrate the broader distinction.

6. Primary versus secondary repairs

   Discussion of how the article frames initial versus repeat or more complex repairs in clinical documentation. The section addresses general factors that can affect how a repair is characterized.