The major changes for orthopedic practices include: mostly changes in the modifiers used in procedures and multiple procedures. Billing strategies include the new codes for kyphoplasty and vertebroplasty, image guidance, and biopsy. How to select coding for myelography, bone tumor ablation, and sacroiliac joint fusion.
One of the most common procedures performed in orthopaedic practices are joint injections. The codes prior to 2015, 20600-20610, represent joint aspiration/injections by joint size. Ultrasound guidance used by many providers to perform these procedures was billed separately using 76942. For 2015, 20600-20610 have been revised to describe these injections without imaging guidance, and three new codes have been added 20604, 20606, 20611 which represent the aspiration/injection of joints with imaging guidance. Because of this change, you can no longer report the ultrasound guidance separately, but when performed 20604, 20606, or 20611 have to be reported.
There also will be a change in the modifiers for CPT codes. Modifier 59 is a catchall that needs to be more defined. There are now four new modifiers to clarify what the indication was. The new modifiers will be XE, XS, XP and XU.
XE- This covers two separate encounters. The patient was treated twice in same day at different times.
XS- This covers separate structures. Such as removing a lesion on the arm and biopsy on the leg.
XP- This covers separate practitioner. Could be the patient had two surgical procedures but by different surgeons in the same day.
XU- This covers overlapping services that are unusual. Maybe there are multiple lesions that would be the same coding, but were removed separately.
As with any coding change, the concern with implementing the 2015 CPT coding is understanding the changes and quickly adapting. Staying abreast of the changes will help to minimize rejections and/or denials, and keep your cash flow steady.
Healthcare Information Services (HIS) can help your orthopedic practice adapt to these and the many constant changes that affect your practice including the big elephant in the room ICD-10. With teams of expertly trained professionals, including over 65 Certified Professional Coders, HIS can help your practice manage change and position your practice for a stable and profitable future.
Many orthopedic practices are now considering third party outsourcing for billing and to manage the complete revenue cycle. This outsourcing has proven to be successful in increasing net revenue streams and saving time of claims having to be filed multiple times due to denials. For practices that choose to outsource their revenue cycle, HIS is a wise choice for practices looking to maximize reimbursements, increase efficiencies, maintain compliance, and boost overall profitability.