Getting paid: AAOS: Use office E/M codes to report ‘optimization’ pre-TKA and THA

Why This Topic Matters

It helps orthopedic practices, coders, and revenue cycle teams understand a current reimbursement debate affecting preoperative care for hip and knee arthroplasty and the related policy context.

Article Sections

1. Presurgical optimization and society advocacy

   Overview of the orthopedic specialty society position on separate reporting for presurgical optimization work before joint replacement surgery. Introduces the organizations and the payment context discussed in the article.

2. Revaluation concerns and bundled payment context

   Discussion of how changes in physician fee schedule valuation and bundled payment arrangements are presented as drivers of the reimbursement issue. Explains the general policy setting without giving coding instructions.

3. Examples of optimization activities

   Broad summary of the kinds of preoperative coordination and preparation activities described by the speakers. Covers the general scope of the work being discussed.

4. Possible CPT reporting approaches

   General discussion of the code categories mentioned as potential ways to report face-to-face and non-face-to-face optimization services. Addresses the reporting framework at a high level.

5. Surgical package and payment obstacles

   Summary of the cited barriers to separate payment, including the surgical package discussion and coverage concerns. Also notes the article’s focus on how current policy may affect billing.