Here are four medical coding strategies every ortho coder needs to know.
If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to figure out which procedures you can claim in reality and get paid for.
Exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice. However it also affects those of the elbow, wrist and hip. On the other hand, it doesn't apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not impact arthroscopically aided procedures. What's more, some surgical knee arthroscopies are excluded from the family -- specifically, 29866-29868.
Here are some sure success medical coding tips:
For scope families, look to CPT
Prior to worrying about how to apply the multiple-endoscopy rule, you must first know why and when it applies. The multiple-endoscopy rule is Medicare's method to avoid double payment (or more) for inclusive services by paying back only a portion of any scope carried out at the same time as another scope of the same basic type.
Here's how the rule functions: CPT divides groups of similar codes into so-called families. The first code describes the basic procedure. Following the base code, CPT lists any variants that go beyond the base code. For instance take this partial code family: 29805, 29806, 29807, and 29819.
Always include the 'base' procedure
Let the say that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply here?
Bear in mind: Family codes always include the work involved in the base code and a surgical scope always includes the diagnostic scope of the same type. As such, you would only code 29807 in this case.
And what about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Again, you should code only the more extensive procedure – in this instance 29822.
If there is no base procedure, you should bill both scopes
If the surgeon carries out two scopes in the same family, neither of which happens to be the base procedure, you should report both codes. Therefore, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for thorough synovectomy, you'd go for both 29819 and 29821.
Keep a watch on your reimbursement
Medicare will shell out money for the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
If your orthopedist carries out several procedures during a knee arthroscopy on the same patient on the same day, you will need to understand the multiple-scope rule to figure out which procedures you can claim in reality and get paid for.
Exception: Remember that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice. However it also affects those of the elbow, wrist and hip. On the other hand, it doesn't apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it does not impact arthroscopically aided procedures. What's more, some surgical knee arthroscopies are excluded from the family -- specifically, 29866-29868.
Here are some sure success medical coding tips:
For scope families, look to CPT
Prior to worrying about how to apply the multiple-endoscopy rule, you must first know why and when it applies. The multiple-endoscopy rule is Medicare's method to avoid double payment (or more) for inclusive services by paying back only a portion of any scope carried out at the same time as another scope of the same basic type.
Here's how the rule functions: CPT divides groups of similar codes into so-called families. The first code describes the basic procedure. Following the base code, CPT lists any variants that go beyond the base code. For instance take this partial code family: 29805, 29806, 29807, and 29819.
Always include the 'base' procedure
Let the say that the doctor has carried out a diagnostic shoulder arthroscopy (29805) plus shoulder arthroscopy for repair of SLAP lesion (29807). How does the multiple-scope rule apply here?
Bear in mind: Family codes always include the work involved in the base code and a surgical scope always includes the diagnostic scope of the same type. As such, you would only code 29807 in this case.
And what about diagnostic shoulder arthroscopy followed by arthroscopic limited debridement? Again, you should code only the more extensive procedure – in this instance 29822.
If there is no base procedure, you should bill both scopes
If the surgeon carries out two scopes in the same family, neither of which happens to be the base procedure, you should report both codes. Therefore, if your orthopedist carries out shoulder arthroscopy with foreign-body removal (29819) followed by shoulder arthroscopy for thorough synovectomy, you'd go for both 29819 and 29821.
Keep a watch on your reimbursement
Medicare will shell out money for the entire fee schedule amount only for the highest-valued scope in a given code family during the same operative session. Medicare carriers will pay any additional scopes in the same family by subtracting the value of the base scope in that family and paying the difference.
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