Orthopedic Billing: The Best Practices to Get Faster Reimbursements (Coding Cheat Sheet)

Managing the revenue cycle for orthopedic healthcare practice is paramount. Implementing a proper revenue cycle ensures improving the orthopedic billing process, which leads to faster reimbursements for services provided by the practitioners.

However, orthopedic billing can be complex as it differs from other medical billing processes. So, accuracy in the orthopedic billing process and orthopedic coding is necessary. 

It reduces the chances of claim denials, which contributes to smoother operations and improves financial health for orthopedic practice. If you want to improve orthopedic billing operations, you have to follow the best practices. 

This blog post shares, best practices for orthopedic billing along with a coding cheat sheet that helps you optimize the billing process.

Related: How to Easily Tackle Denials in Wound Care Billing to Improve Cash Flow

Understanding Orthopedic Billing and Coding Cheat Sheet

Orthopedic billing and coding is a tool that medical professionals use to streamline the complete orthopedic procedures of billing and coding. This typically includes:

• Common orthopedic CPT codes for procedures and services
• ICD-10 codes for orthopedic diagnoses and conditions
• Modifiers specific to orthopedic billing
• Guidelines for documenting medical necessity

By having this accessible resource readily available, medical coders and billers can ensure accuracy and completeness in submitted claims. This ensures improving the financial health of orthopedics practice.

Healthcare practitioners can use the cheat sheet to maintain regulatory compliance and protect their procedures from possible financial penalties and audit monitoring.

Best Practices to Improve Orthopedic Billing to Get Faster Reimbursements

Healthcare providers should follow the best practices to optimize orthopedic billing. Here are the best practices to improve orthopedic billing:

Accurate patient information collection 

• One of the most important parts of medical billing is collecting accurate patient information.
• Orthopedic Practices should ensure that the front office staff members are trained enough to do this process efficiently.
• The patient information includes patient demographics, current insurance information, contact information, and relevant medical history.
• To ensure accuracy, implement the double verification check system to minimize errors.
• Also, utilizing digital forms will reduce manual data entry mistakes.

Proper documentation of medical necessity 

• Medical necessity documentation is crucial as it is the proof provided to the insurance companies to justify the orthopedic medical service.
• This documentation should clearly describe the patient’s conditions and symptoms.
• Medical necessity documentation should be in detail the explanation for choosing the treatments and procedures for the patients.
• The documentation should be attached with all the relevant diagnosis test results.
• Also, ensure documentation of how the treatment plan addresses the patient-specific health conditions.
• For best practices, use standardized templates to ensure consistency and completeness in medical documentation.

Timely claim submission 

• To get faster reimbursements, practices should timely and properly submit medical claims to insurance companies.
• Practices should ensure setting up a system to submit claims daily.
• Also, establish strict deadlines internally so that staff members and others will work effectively for claim preparation.
• Assign a dedicated staff to continuously monitor claim status to identify and address any delays.
• Practices should ensure submitting claims within 24 to 48 hours of service provision to improve cash flow.

Obtain Prior Authorization

• Practices should consider obtaining prior authorization from the staff members who are dedicated to the payer policies and requirements for orthopedic procedures.
• This will ensure that the orthopedic procedures are medically necessary and will be covered by the patient’s insurance.
• Insurance payer’s policies and requirements vary.
• So, it is crucial to understand and navigate the complexities efficiently to avoid claim denials.

Implementing advanced billing software

• Healthcare practices often utilize billing software to streamline the billing process.
• Consider choosing the best-advanced billing software that is specially designed for orthopedic practice.
• For more efficiency, ensure integrating the billing software with your EHR system to enable a seamless data flow.
• The software solutions often have built-in coding assistance and claim scrubbing feature which helps to fasten the claim preparation process for orthopedic billing.

Staying Updated with the Orthopedic Coding

For all medical practitioners, coders, billers, and administrators in orthopedic clinics, billing, coding, and prompt reimbursement are critical. 

We have listed a few sites that offer advice on correct coding, billing procedures, compliance, and practices related to orthopedic treatment reimbursement.

• American Academy of Orthopaedic Surgeons (AAOS) – AAOS provides updates on coding changes and guidelines relevant to orthopedic surgery.
• American Health Information Management Association (AHIMA) – AHIMA offers education resources, coding tools, and updates related to health information management, including coding and reimbursement in orthopedic practice.
• American Academy of Professional Coders (AAPC) – AAPC offers orthopedic-specific training, certification programs, and forums.
• Centers for Medicare & Medicaid Services (CMS) and Medicare Learning Network (MLN) – MLN offers free resources, including educational seminars, publications, and guides to help medical practitioners with Medicare-related coding and billing concerns. It addresses significant reimbursement subjects.

Related: Medical Billing Audit: Everything You Need To Knowhttp://Medical Billing Audit: Everything You Need To Know

Orthopedic Medical Coding Cheat Sheet

Here is the coding cheat sheet which includes:

Commonly used CPT Codes

CPT codes (Common Procedure Terminology) are codes that are used to describe specific medical, surgical, and diagnostic services provided by healthcare providers. 

Here are the commonly used CPT codes for orthopedic billing and coding.

Procedure	CPT Code
Arthroscopy, knee	29877
Arthrocentesis, aspiration, injection	20600-20611
Total hip arthroplasty	27130
Total knee arthroplasty	27447
Closed treatment of fracture	28515
Open treatment of fracture	11010-11012
Repair of rotator cuff	23410
Repair of ACL	29888
Carpal tunnel release	64721
Spinal fusion	22554

Commonly Used ICD-10 Codes

These are the alphanumeric codes that are used to record particular illnesses and diagnoses. 

These codes in orthopedics represent diseases like M17.11, which is unilateral primary osteoarthritis of the right knee. Healthcare professionals can accurately document diagnoses and communicate comprehensive information about a patient’s condition by using these codes. 

Here are the commonly used ICD-10 codes:

• S72.001A – Fracture of Neck in right femur, initial encounter for closed fracture.
• M17.11 – Unilateral primary osteoarthritis of the right knee
• S82.101A – Displaced fracture of medial condyle of right tibia, initial encounter for closed fracture
• M67.02 – Short Achilles tendon (acquired), right ankle.
• S43.401A – Sprain of unspecified rotator cuff capsule, right shoulder, initial encounter.
• S42.001A – Unspecified fracture of shaft of right humerus, initial encounter for closed encounter.

Modifiers

Modifiers in medical coding offer additional information to procedure codes. 

It is a two-character code that is added to the main procedure codes. They provide additional information about a service or procedure that the base code itself doesn’t capture.

Here are the common modifiers used in orthopedic medical billing and coding:

• -51 (Multiple Procedures) – This modifier is used if the same physician performed multiple procedures during the same surgical session. It includes diagnostic imaging services performed during surgical sessions.
• -59 (Distinct procedural service) – This modifier indicates that the procedure is different or independent from other services performed on the same day.
• -LT/-RT (Left/Right side) – These modifiers are used to specify whether the procedure is performed on the left side of the body or the right side of the body. It is often used in orthopedic procedures where only one side of the body is affected.
• -50 (Bilateral procedure) – This modifier indicates that a procedure was performed on both sides of the body. It is different from the -LT and -RT modifiers, which are used to specify that a procedure was performed on one side of the body only.
• -76 (Repeat procedure by the same physician): This modifier indicates that a procedure was repeated by the same physician on the same day. It is typically used when the first attempt of a procedure is unsuccessful.
• -22 (Increased procedural service): It is used to indicate that a procedure is more complex than usual. It may be used if the procedure took longer to perform than usual, or if it was more difficult to perform than usual.

CapMinds Revenue Cycle Management Solution for Your Healthcare Practices Financial Success

Effective revenue cycle management is essential to improve healthcare practices’ financial health. 

To avoid the drawbacks, minimize claim denials, and improve your revenue cycle management, an expert must be put into use in your practice.

At CapMinds, we are bringing a comprehensive solution to make your billing and coding experience better. Our medical billing team expedites your entire billing process. Utilizing our Revenue Cycle Management Solution, your healthcare practice benefits from:

• 24/7 Support: Always available for your queries.
• Dedicated Client Manager: Personalized service for your practice.
• Efficiency and Accuracy: Streamlined billing, fewer claim denials.
• Financial Optimization: Maximize revenue, and correct underpayments efficiently.
• Enhanced Cash Flow: Timely collections, and improved financial management.
• Compliance and Security: Adhere to industry standards always.

We optimize your charges, submit your claims, provide on-time collection, reduce accounts receivables, identify underpayments, and increase your practice’s net collections, thereby better clinical and service expansion.

We also have a dedicated client manager who will be exclusively assigned to you. And the team will be available around the clock to assist with your queries. 

“Reach out to CapMinds to make your medical billing process easier and more effective”