Saturday, December 2, 2023

Orthopedic Coding Cheat Sheet 2022

Put Time On Your Side In 2021

Real World Medical Coding – “Cheat Sheets”

The new E/M rules will only affect office or other outpatient visit E/M codes . It will not carry over into the hospital inpatient codes, or any other E/M codes where time is an element that can be used for code selection, Jimenez clarifies. Also, CPT® code 99201 will be deleted in 2021.

Time is always important when coding office E/M services in an orthopedic practice. When commenting on coding E/M services based on time, Jimenez notes: In some specialties you just see it more. Orthopedics, anytime you have surgeons involved. Lots of times, the scenario around that E/M encounter is discussion we need to talk about options here.

Not only will you need to adjust your coding to make time an overarching determinant in E/M coding in 2021, but youll also need to get used to the new definition of time for E/M coding purposes, Jimenez says. Time will be redefined from face-to-face time to total time spent on the day of the encounter.

Cervical Spine Disorders And Displacement

M50.22 Other cervical disc displacement, mid-cervical region M50.23 Other cervical disc displacement, cervicothoracic region M50.30* Other cervical disc degeneration, unspecified cervical region M50.31 Other cervical disc degeneration, occipito-atlanto-axial region M50.32 Other cervical disc degeneration, mid-cervical region M50.33 Other cervical disc degeneration, cervicothoracic region M50.80* Other cervical disc disorders, unspecified cervical region M50.81 Other cervical disc disorders, occipito-atlanto-axial region M50.82 Other cervical disc disorders, mid-cervical region M50.83 Other cervical disc disorders, cervicothoracic region M50.90* Cervical disc disorder, unspecified, unspecified cervical region M50.91 Cervical disc disorder, unspecified, occipito-atlanto-axial region M50.92 Cervical disc disorder, unspecified, mid-cervical region M50.93 Cervical disc disorder, unspecified, cervicothoracic region

Medical Decision Making And Time Take Center Stage In 2021

Orthopedic offices will have some special challenges when adjusting to 2021 evaluation and management coding expectations. Coders anticipating the sweeping changes to E/M office and other outpatient visit coding next year should prepare now.

You will no longer use history and examination as factors in deciding overall E/M levels. For 2021 office E/M services, explains Raemarie Jimenez, CPC, CIC, CPB, CPMA, CPPM, CPC-I, CCS, senior vice president of product at AAPC, the level of service will be based on time or MDM not both one or the other.

In her AAPC webinar 2021 E/M Guideline Changes: Orthopedics, Jimenez, who is coding liaison to the AMA CPT® Editorial Panel, shows attendees how to apply these changes to cases they might encounter next year. Step into the virtual world of this presentation for a look at some ortho-specific advice on E/M coding in 2021.

Don’t Miss: East Valley Foot And Ankle

Cpt Modifier List For Performance Measurement

CPT Modifier List Category II

Category II modifiers are called performance measurement modifiers and indicate that a service was considered but was not provided due to patient, medical or system circumstances.

Report CPT modifiers from category II only if the procedure can not be reported with category I or III.

Below is the list of category II modifiers.

Gail I Smith Ma Rhia Ccs


Gail Smith, president of Gail I. Smith Consulting, is a nationally recognized coding educator. For most of her career Gail was an associate professor and director of the health information management program at the University of Cincinnati and HIM program director at Cincinnati State Technical and Community College. Gail is a currently a consultant with a software company specializing in medical terminologies. Gail has authored several textbooks, including Basic Procedural Terminology and HCPCS Coding published by the American Health Information Management Association .

An advocate for advanced coder training, Gail is the author of several titles for Libman Education including CPT: Introduction to Procedural Coding and two courses on the unique challenge of CPT coding in the pediatric setting: CPT for Pediatrics and CPT for Pediatrics: Advanced Orthopedic Coding. According to Gail: One cannot possibly teach every coding scenario a coder will experience in their career. That is why coding education needs to focus instead on how to arrive at an accurate and defensible code assignment. It is the difference between learning to fish, and being given a fish. If you learn to code instead of being given answers to memorize, you will be able to arrive at the complete codes more quickly and with greater confidence.

Gails course is great, I am enjoying! on Gail I. Smiths course ICD-10-CM for Coding Professionals

Also Check: How To Tape Ankle Sprain

Mdm Could Make Or Break 2021 Claims

In addition to making medical decision making one of the two deciding factors for E/M code selection in 2021, CPT® will make these changes to the MDM component descriptors :

  • Number of Diagnoses of Management Options will become Number and Complexity of Problems Addressed.
  • Amount and/or Complexity of Data to be Reviewed will become Amount and/or Complexity of Data to be Reviewed and Analyzed.
  • Risk of Complications and/or Morbidity or Mortality will become Risk of Complications and/or Morbidity or Mortality of Patient Management.

Check Out This Base Code Cheat Sheet

Find the Base arthroscopic procedure fast.

If you want to find the base code for a given arthroscopic procedure, you can always look to the ENDO BASE column of the 2016 National Medicare Physician Fee Schedule Relative Value File — or you can just check this convenient cheat sheet.

Note: The family concept does not apply to the ankle, subtalar, or MCP arthroscopy codes, which have no base code.

Don’t Miss: Orthopedic Doctors In Suffolk Va

Top Physical Therapy Cpt Codes

Current procedural terminology codes are used to designate services provided by healthcare professionals. We physical therapists receive compensation for our services depending on how we bill using these CPT codes. If we dont properly bill for our services provided, we could be losing out on valuable income. This article aims to be a useful resource for any PTs using physical therapy CPT codes.

I initially wrote this article in 2016 at the beginning of my career in the field of physical therapy. At the time, I had no idea just how popular the article would become . In school, we do not learn much, if anything at all, about using CPT codes properly and maximizing reimbursement. However, we are all expected to do so when we begin working. The climate for outpatient PT practice is changing quickly, and so it is more important than ever that we as clinicians understand how to use these codes properly in order to protect our profession and keep our practices thriving.

Since writing this article, I have taken on roles as supervisor and clinic director. These are positions that require a superior knowledge of this subject matter. I’ve made some edits to this article to help you understand billing procedures with a little more clarity.

Category Of Code For Medicare And Other Payers That Dont Recognize Consult Codes

CPC Exam Survival Guide 2022 – What you NEED to know BEFORE taking the test

When CMS stopped paying for consults, it said it still recognized the concept of consults, but paid for them using different categories of codes. For an inpatient service, use the initial hospital services codes . If the documentation doesnt support the lowest level initial hospital care code, use a subsequent hospital care code . Dont make the mistake of always using subsequent care codes, even if the patient is known to the physician.

For office and outpatient services, use new and established patient visit codes , depending on whether the patient is new or established to the physician, following the CPT rule for new and established patient visits. Use these codes for consultations for patients in observation as well, because observation is an outpatient service.

For patients seen in the emergency department and sent home, use ED codes .

Also Check: El Paso Orthopedic Surgery Group

Coding Tips For Busy Orthopaedic Practices

  • 1. Coding Tips for theOrthopaedic OfficeLynn M. Anderanin, CPC,CPC-I, COSC AHIMA ICD-10-CM Certified Trainer
  • 2. Healthcare Information Services HIS is a physician management company based in Chicago, IL specializing in Revenue Cycle Management and Information Technology. HIS provides services for over 450 providers and has a dedicated Orthopaedic Division. HIS is dedicated to helping physicians maximize their reimbursement revenue, lower overhead and enhance your bottom line. HIS is an expert partner for increased profitability for your Orthopaedic practice. 2
  • 3. Presenter – Lynn Anderanin Lynn Anderanin, CPC,CPC-I,COSC is the Sr. Director Coding Compliance and Education for Healthcare Information Services . She has over 28 years experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations. Lynns experience is primarily in the specialties of Orthopedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, audio conferences, and Local Chapters. Lynn became a CPC in 1993, and a Certified Instructor in 2002, and a Certified Orthopedic Surgery Coder in 2009. Lynn is the founder of the first local Chapter of the AAPC in Chicago, which is now 15 years old, and a former member of the AAPC National Advisory Board as well as other Boards for the AAPC. 3
  • Cpt Modifier List For Provider Services And Ambulatory Service Centers

    Below is the category I modifier list for provider services and ambulatory service centers. This list of modifiers ranges from 22 to 99.

    CPT Modifier ListCategory I

    What is modifier 21? Prolonged evaluation and management services.

    Note: Modifier 21 was deleted on 01-01-2009. Please use CPT 99354 CPT 99359 instead.

    When to use a 21 modifier? Modifier 21 is used when the face-to-face service provided is prolonged or otherwise greater than usually required for the highest level of evaluation and management service within a.. Read more..

    Modifier 22 can be billed for increased procedural services. The circumstances of the surgery need to be unusual and require more mental and/or physical work from the surgeon than normal.

    Don’t Miss: Swollen Feet And Ankles During Pregnancy

    Top Cpt Codes And Modifiers For Orthopaedics Billing Services

    Orthopaedic treatments look after issues like injuries, congenital deformities or abnormalities, and diseases pertaining to the musculoskeletal system. No matter what the nature of Orthopaedic specialization your clinic specializes in, successful billing practices need that your medical billing specialist is expert and experienced in completing the coding demands relative to the specialty field.

    Correctly interpreting the information and proper application of codes, modifiers, and extensions help creating and flawless functioning of proper revenue stream for the practice by reducing claim rejections and denials. Following every guideline put by CMS , Orthopaedic specialist coders at 24/7 Medical Billing Services offer medical billing services to pump up your revenue cycle.

    Implementing ICD-10 has brought around 264 new codes, 143 deleted, and 134 revised codes that are applicable to coding for an Orthopaedic practice. New rules with modifier 59 and the introduction of the applicable modifiers XU, XE, XP, and XS are revolutionizing Orthopaedics billing from here. Our team of Orthopaedic billing professionals displays their knowledge of the ICD-10 and proficiency in multiple ways in which the new requirements and coding changes impact Orthopaedics.

    The 11 Most Common Physical Therapy Cpt Codes

    Optimize the Schedule Using Templates
    • 97110: Therapeutic Exercise
    • 97750: Physical Performance Test or Measurement
    • 97761: Prosthetic Training
    • 292**, 295**: Strapping
    • 90901, 90911: Biofeedback

    Most of the new edits have been to the Common CPT Codes and Their Usage section, where you’ll find expanded descriptions and other helpful updates.

    While most of us got into this profession for the pure enjoyment of working with people who need our help, money still controls our profession, as it does in any other field.

    The payment we receive for our services is based on the resource-based relative value scale , which takes into consideration the work performed, the expense to the practice, and the liability and risk in providing the services or procedures.

    Now, I dont know about you, but I sure didnt learn much about proper billing when I was in PT school. This is one of the topics that we are expected to learn on our own as we embark on our clinical affiliations and careers.

    Depending on thephysical therapy setting in which you practice, and the site in which you are placed, you will find that people have different opinions on what constitutes proper use of these physical therapy CPT codes.

    Read Also: Advanced Foot And Ankle Of Wisconsin

    Changes Marked By New Add

    Heres how 99211 will be slightly different next year, too.

    The AMA has released its 2022 list of additions, revisions, and deletions for the next CPT® code book. For orthopedic coders, its going to mean getting used to a few brand-new codes, revisions to a few more codes, and the elimination of a couple more.

    Breakdown: There are more than 400 new, revised, and deleted codes for 2022 most of them go into effect on Jan. 1, 2022, meaning you have plenty of time to adjust.

    Check out this quick rundown on all the CPT® changes youll need to know to optimize your orthopedic coding in 2022.

    Use New Add-ons for Laminectomies

    The latest CPT® code list includes the following two new codes:

    • +63052 , during posterior interbody arthrodesis, lumbar single vertebral segment )
    • +63053 , during posterior interbody arthrodesis, lumbar each additional segment )

    Analysis: These codes will be the last two entries in the CPT® section titled: Posterior Extradural Laminotomy or Laminectomy for Exploration/ Decompression of Neural Elements or Excision of Herniated Intervertebral Discs. The code set currently ranges from 63001 , partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root thoracic, single segment) through 63051 ).

    Orthopedic coders will also want to note the following quartet of radiology codes set to debut in 2022:

    Descriptor Tweaks for Language Mark Most Revisions

    2021 descriptor: are minimal.)

    2021 descriptor:

    Closed Fracture Treatment Needs A Medical Supply

    We have learnt about aftercare and followup fracture coding. But, for the procedure codes involves use of material to immobilize a joint and allow the separated bone parts to fuse together. Materials used are generally casts, splints, braces, canes, walking boots and crutches.

    The documentation of the material used for immbolization of joint is very important to indicate the plan for followup care of the fracture, the non-operative non-manipulative fracture care codes then only be reported.

    If the documentation does not support or mention any of the medical supply or materials used for closed fracture treatment, then it will be considered as general office visit. In such cases and an appropriate E/M code for subsequent or related visit should be reported.

    Although non-operative , non-manipulative fracture care services are not surgical , they carry a 90- day global period. As such, if an E/M service is provided on the same day as fracture care, in such a case modifier 57 decision for surgery must be appended to the E/M code.

    Let us checkout the important materials needs to be documented for reporting non-surgical/non-manipulative fracture:

    Item provided

    Important rules for Fracture coding

    Let use also checkout list of few CPT codes used for treatment of closed fractures in surgery.

    Fracture site

    Don’t Miss: How To Strengthen My Ankles

    The Billing Black Hole

    I remember my first few months of trying to figure out how to properly bill in order to please the insurance companies and to meet my own clinics expectations.

    It was odd to me that there was so much widespread uncertainty involved in such a vital part of what we do on a daily basis as clinicians.

    • How could this topic be so sensitive and debatable?
    • Dont insurance companies want to clearly define what procedures they will be paying for?
    • How will I know how to bill for my patients time in the clinic if I dont truly understand what the codes even mean?

    Those tasked with the job of creating and modifying Medicare legislation and reimbursement must have some idea of what they are doing. Payable criteria for each billing code must remain vague and undefined in order to give the insurance company the power to deny our claims if they feel our services arent necessary or warranted. To them, if a patient is considered functional, they no longer require skilled physical therapy intervention.

    When it comes down to it, insurance companies are businesses. Their main job isnt to provide affordable, high quality healthcare services to all who sign up for their services. Rather, their goal is to turn a profit.

    The net profit of the industry over the past 10 years has equaled almost half a trillion dollars. Aetna alone reported a revenue of over $60.3 billion in 2015, a record for the company despite insurance companies sobbing over the passing of the Affordable Care Act in 2010.

    Knowledge Is Power When It Comes To Physical Therapy Cpt Codes

    2021 E& M Medical Coding – How to Level E& M Code

    It would be fruitless to spend our valuable emotional energy struggling with the false idea that everyone who needs quality care will get the necessary funding from their insurance companies, especially since our patients already require so much of this energy on a daily basis.

    We need to be informed of how to properly bill for our services to ensure small business success.

    We need our private practice clinics to thrive so that they may continue to serve our communities and the patients who need us.

    We owe it to our profession to be knowledgeable about how to properly and legally submit claims for our services. The future of reimbursement for physical therapy services may depend on it.

    Don’t Miss: St Vincent’s Orthopedic Doctors

    Osteoarthritis Of The Knee

    M17.0 Bilateral primary osteoarthritis of knee M17.10* Unilateral primary osteoarthritis, unspecified knee M17.11 Unilateral primary osteoarthritis, right knee M17.12 Unilateral primary osteoarthritis, left knee M17.2 Bilateral post-traumatic osteoarthritis of knee M17.30* Unilateral post-traumatic osteoarthritis, unspecified knee M17.31 Unilateral post-traumatic osteoarthritis, right knee M17.32 Unilateral post-traumatic osteoarthritis, left knee M17.4 Other bilateral secondary osteoarthritis of knee M17.5 Other unilateral secondary osteoarthritis of knee M17.9* Osteoarthritis of knee, unspecified

    Consulting Physician Services For Hospitalized Medicare Patients


    What should a consulting physician bill when seeing a hospitalized Medicare patient? An initial hospital service or a subsequent hospital visit?


    Medicare stopped recognizing and paying consult codes, but consults are still requested and provided to inpatients every day. The question is, how should they be billed?

    If the documentation supports an initial hospital service, use codes 99221-99223, initial hospital care codes. According to CPT®, these codes are used for new or established patients. While we think of them and even talk about them as admission codes, CPT® doesnt use that word.

    If the documentation doesnt have a detailed history and detailed exam, then bill a subsequent hospital visit, rather than the initial hospital care services. But, the correct category of code is initial hospital care. The citation from the Medicare Claims Processing Manual is at the end of this Q& A.

    Many commercial insurance companies still recognize consults. Neglecting to bill consults when the carrier pays them results in lost revenue.

    You May Like: How To Make Your Ankle Stop Hurting

    Popular Articles
    Related news