Coding Changes and Tips Healthcare Providers Should Be Aware Of

Healthcare News

HIS - Coding Changes

If you work with a healthcare practice, you know that proper coding practices are key to efficiency and acceptance of submissions by insurance carriers. Each member of your orthopedic or radiology practice who plays a role in the coding process should be aware of proper tips and relevant updates to coding requirements, so that your practice can continue to run as smoothly and successfully as possible even after your patient has walked out the front door. At Healthcare Information Services, we are proud to provide expert revenue cycle management services, which include coding work from our team of over 65 Certified Professional Coders. Along with our many services, we strive to keep those in the healthcare industry up to date on coding and any tips that we feel are important to know. Below, we’ll walk you through some recent changes and tips that will make your practice’s coding process more effective, so read on to learn more.

Diagnosis Coding Tips

Those who regularly submit musculoskeletal ICD-10-CM codes are aware of the fact that these codes have a choice of left, right, or bilateral. Choosing the most relevant option when submitting this type of code is essential, because many insurance carriers have been warning that a denial may occur when a code with a laterality option is not reported. When these carriers receive information on this procedure with an unspecified code, they will not be able to accept it, which can lead to more hassle for your practice. Another element of coding to be aware of is related to the code for lumbar spinal stenosis, M48.06. This code was split into two separate codes in 2018, but many charges for the invalid code are still being received. Ensure that everyone at your practice is aware that they should be submitting one of two options when submitting this type of code- M48.061 (spinal stenosis, lumbar, without neurogenic claudication) or M48.062 (spinal stenosis, lumbar, with neurogenic claudication). Submitting the correct code the first time will help your practice maintain efficiency and ensure that all submissions are accepted without any further communication required.

CPT® Coding Tips

One of the current denial trends in surgery claims is arthroscopic debridement in the shoulder. In order to ensure that your claims for this treatment are not denied, you should be sure that the documentation is clear as to what areas are debrided, which indicates whether the procedure was limited or extensive. This treatment has two different codes, which are chosen based on the specifics of the individual procedure, detailed below. Healthcare providers should also be aware that arthroscopic biceps tenotomy is considered to be a part of debridement, and should be coded or included in the below codes.

  • 29822 – limited debridement of soft or hard tissue. This code includes anterior or posterior compartment debridement of the labrum, cuff, cartilage, or osteophytes.
  • 29823 – extensive debridement of soft or hard tissue. Differing from the previous code, this code includes anterior and posterior compartment debridement, along with chondroplasty of the humeral head or glenoid and associated osteophytes. Multiple soft tissue structures (such as labrum, subscapularis, and supraspinatus) are also included under this code.

Along with being aware of the specific codes used for arthroscopic debridement, there are other guidelines for this procedure detailed in Medicare’s NCCI policy manual that can apply to many insurance carrier policies. Healthcare providers should be aware of the fact that when submitting claims, the shoulder is considered a single anatomic structure. Code 29822 (for limited debridement) is included in submissions for other shoulder arthroscopy procedures- this code should only be reported when it is the only procedure that was performed. Code 29823 functions differently. It cannot be reported with any other shoulder arthroscopy procedure, and the debridement must be extensive in a different area of the shoulder. Exceptions to this rule include:

  • 29824 – distal claviculectomy
  • 29827 – rotator cuff repair
  • 29828 – biceps tenodesis

Optimize Your Coding Process with Help from HIS

We hope that you now feel more informed about current coding issues, so your practice can submit claims more efficiently and confidently. At Healthcare Information Services, we are proud to provide expert-level RCM and practice management services, meant to benefit your practice through maximized reimbursements, increased efficiencies, and improved profitability. When you outsource your RCM to us, you’ll be able to give your full focus to your patients and never worry about dealing with coding or billing errors that can disrupt your operations. We want to help your practice prosper and grow- please contact us today to learn more about what we can accomplish for you.