If you are an orthopedic surgeon, then you know that a significant percentage of a practice’s revenue is generated in the O.R. If you are seeking ways to increase surgical reimbursements, perhaps it’s time to ask, Are you doing everything that you can to maximize that revenue?
Surgical cases are often complex, requiring multiple procedures to resolve a patient’s ailments. This is particularly true in the field of Orthopedic Surgery. Our bodies are complex biomechanical structures and can be affected by numerous conditions requiring surgical intervention.
Your patients deserve the relief that your expert surgical treatments provide, and you deserve to be fully reimbursed for all necessary and separate procedures as far as reimbursement guidelines will allow.
The simple answer to how you can be sure you are maximizing reimbursements on your surgical cases is by turning to an experienced team of certified orthopedic coders. CPC certification by the AAPC has become the gold standard with additional specialty certification available such as AAPC’s COSC (Certified Orthopedic Surgical Coder).
“Specialty providers deserve specialty coders.” At Merem Healthcare Solutions, that’s what we believe and that is what we provide to Orthopedics and Sports Medicine practices. We believe that every client deserves the expertise of experienced CPC coders; additionally, we employ COSC coders for their specialized knowledge pertaining to complex orthopedic surgical cases.
We asked our expert coders: “What is the #1 thing surgeons can be doing to increase their surgical reimbursements?”
“What is the #1 thing surgeons can be doing to increase their surgical reimbursements?”
You may be surprised by the answer: Improve Documentation. Your documentation is the key to your reimbursements and the profitability of your practice.
Documentation such as the operative report and op notes are the only way a coder can translate the procedures performed into billable revenue via (CPT codes). Incomplete or vague documentation can lead to a major loss in billable revenue. You know what procedures you performed but remember, you can only get paid for what your notes say you performed.
In our experience working with practices across the country, we have seen that some surgeons are in the habit of providing their staff with the codes they want to be billed.
For some surgical cases, these codes may be accurate and supported by the documentation. Although in some cases, if not reported correctly, this act can be seen as healthcare fraud or abuse.
Could you be leaving money on the O.R. table?
- What if there are additional codes that could have been billed?
- What if the documentation does not support the codes given and the payer performs an audit?
The answer to both questions is –Revenue Loss.
After reading and coding thousands of surgical operative notes, the medical coding experts at MEREM Health have provided five examples you can reference to ensure you are maximizing reimbursement while maintaining billing and coding compliance.
Five Orthopedic Procedure Examples For How To Maximize Reimbursements & Maintain Coding Compliance
#1 Abrasion Chondroplasty – 29879 – 19.05 RVUs
A chondroplasty is often performed in conjunction with a meniscectomy; so much so, that NCCI guidelines will not allow for a traditional chondroplasty (29877) to be billed when performed with a meniscectomy on the same knee on the same day.
This is where accurate and descriptive documentation comes into play. If the chondroplasty is performed using a microfracture/osteochondral drilling technique, the procedure can be billed as an abrasion chondroplasty increasing your case’s billable RVU total by 19.05.
The key to correctly documenting and billing this procedure is that your op note must support that the debridement/microfracture/drilling went down to bleeding bone. Absent this key phrase, the chondroplasty cannot be coded as 29879 while maintaining compliance.
#2 Extensive Synovectomy vs Limited Synovectomy
It is important to think of Extensive/Limited or Major/Minor as a quantitative description rather than a qualitative description. It is all about the number of compartments.
To appropriately bill an Extensive Synovectomy (29876), the documentation must clearly support that synovium was excised from at least 2 compartments of the knee.
Additionally, for either synovectomy code to be reported, the documentation must support the necessity due to a pathological disease process and not simply for visualization purposes. For this procedure, your incomplete dictation could cost you anywhere from 4.69 to 18.92 RVUs.
#3 Mumford Procedure (Distal Claviculectomy)
With a distal claviculectomy procedure, it is important to note the size of the bone that is being removed. Per CPT and AAOS guidelines, this procedure is reportable as 29824 (19.15 RVUs) if 8-10mm or more of the clavicle is removed.
If less than that amount is removed, or if the size is not reported, the procedure would only qualify as a debridement. This error could cost 2.76 RVUs.
#4 Bankart and SLAP repair (same session)
Per AAOS, capsulorrhaphy (29806) for a Bankart repair, and SLAP repair (29807) are reportable on the same date of service when documentation supports the repair of type II or type IV SLAP lesion, in addition to the Bankart repair. Failing to document the grade of the SLAP tear, 29806 would not be separately reportable at a cost of 30.58 RVUs.
# 5ORIF of a Distal Radius Fracture
It is important to document if the fracture was intra-articular or extra-articular. You will also need to document how many fragments were fixated.
There are three different codes: 25607 (extra-articular), 25608 (intra-articular fracture, with fixation of 2 fragments), or 25609 (intra-articular fracture, with fixation of 3 or more fragments). Depending on which code the documentation supports, RVU values range from 21.08 to 30.08.
These most common orthopedic procedure scenarios could be causing you to leave money on the operating table, but there are so many more.
At MEREM Healthcare Solutions, we believe that orthopedic surgeons and all of our clients should be able to focus on what they do best. While you focus on restoring patients to their best musculoskeletal health, detailed documentation is imperative. Let MEREM Health worry about your procedure codes!
Our Specialized Orthopedics and Sports Medicine Coding Solutions Include:
- All clinical and surgical documentation reviewed by Certified Coders
Coding completed within 48 hours from receipt of all source documentation - Coding experts that can educate your staff to ensure appropriate documentation and compliance
- Regular internal audits to monitor coding performance, accuracy, and compliance
- Quarterly reports on provider-level coding and documentation performance
Op notes are never written in stone, so from Day 1 our experts will ask you the right questions so that addendums can be made for your current cases, all while coaching you to documenting iron-clad operative reports.
Find out if you are leaving money on the operating table! MEREM Healthcare Solutions will make your orthopedic practice more profitable!
Contact the medical coding experts at MEREM Healthcare Solutions today for a FREE coding audit of 15 surgical cases. Call (205) 329-7519 or click here to learn more about our revenue cycle improvement and auditing process for orthopedic and specialty medical practices.
Request A Consultation with MEREM Healthcare Solutions today.