Maximize Orthopedic Billing Codes to Grow Your Revenues

Many factors come into play when trying to optimize your practice’s resources and ability to generate revenue. Two of the most significant are medical billing and the accuracy of the claims your practice files. 

Medical billing and coding specialists earn degrees to do their jobs because it’s a highly technical field not easily understood by outsiders. They have to know the ins and outs of Current Procedural Terminology (CPT), ICD-10 codes, and the Healthcare Common Procedure Coding System (HCPCS).

A lot rides on accurate medical billing, including patients being fairly charged for services and providers earning the appropriate revenue.

No matter what area of orthopedics you practice, ensuring that your medical billing and coding departments are operating efficiently means more revenue and opportunities for expansion. 

Here are the top strategies you can employ to make the most of orthopedic billing codes.

Train your staff properly

Train your medical coders on the workings of your practice and correct billing services, so they don’t miss out on opportunities for collecting revenue and don’t inadvertently bill patients incorrectly. 

When staff members aren’t well-versed in the procedures, treatments, and consultations you offer, as well as the most updated CPT and ICD-10 codes, they can make mistakes regarding appropriate codes and bundling tactics. These errors can result in claim denials from insurance companies, which is not only a headache to deal with — it could also mean lost revenue for your practice.

Have updated codebooks on hand for staff to reference or implement software like CureMD or DrChrono. These tools are designed to help practices achieve higher payment collections and avoid claim rejections through revenue cycle management solutions.

Also, be sure to provide opportunities for ongoing training for your medical billing staff, as code regulations are regularly updated.

Bundle codes for a more straightforward process

Code bundling is a strategy healthcare providers use to combine services on a bill. 

When done correctly, it decreases the paperwork and other administrative work and simplifies the billing process because patients and insurance companies receive one bill instead of multiple. Simplified billing can result in accurate payments from the get-go and less back and forth disputes about bills between your staff and patients.

Say you have a patient with a rotator cuff injury. If the patient gets a bone X-ray and you then treat them for the broken bone, your practice can bundle the services together instead of billing them separately.

Always ensure the more significant or complex (and typically, the more expensive) procedure is the code used when bundling codes for two or more procedures performed simultaneously.

Use modifiers

Modifiers in CPT medical coding provide additional details about a patient’s status, service, or procedure performed. Modifiers also ensure the physician gets paid for the full scope of their work.

Modifiers are significant during the global period (up to 90 days post-surgery) because related services, follow-up exams, and procedures can’t be billed separately from the overall surgical package during that time. In addition, physicians can use modifiers to bill for a new diagnosis or other postoperative care that might not fall under the parameters of the global period.

Some of the most common modifiers include Modifiers 58 (a procedure within the global period), 59 (a distinct procedural service), 76 (a repeat procedure), 78 (an unexpected surgery or related procedure or service in the global period), and 79 (a procedure or service that’s unrelated but performed by the same doctor in within the global period).

Modifiers generate revenue because they can show how a surgeon changed a procedure due to a particular factor. For example, if a physician performs a bilateral knee aspiration, they would add Modifier 59 to the CPT code. Hence, billing knows, and the physician gets paid for performing the procedure on both knees.

Misused modifiers can lead to audits, penalties, and lost revenue. Becoming familiar with the various modifiers ensures you’re using the right one and not losing money due to the wrong application.

Spot unbundling errors

Unbundling refers to when one procedure is billed as several separate codes when one designated CPT code would do the job. Unbundling errors occur when a practice codes procedures separately that should have been bundled. 

If you discover an unbundling error, it needs to be addressed quickly, so you don’t receive claim denials and potentially lose reimbursement from payers, including insurance companies and Medicare.

Modifier 59 is known as the “unbundling modifier.” It allows you to bill separately for multiple services that normally would have to be included under one code. Modifier 59 should be used when coding for a different procedure or anatomic location.

Compare medical records of individual patients with the doctor’s notes on the procedures they’ve performed with the codes used in billing to ensure everything matches up and avoid unbundling errors.

Stay up to date with code revisions

Medical coding undergoes regular updates and modifications on how physicians can bill for services. By keeping informed about these changes, you ensure your coding and billing are accurate and reflect the most recent regulations.

Some E/M (evaluation and management) codes were updated on Jan. 1, 2023, according to the American Medical Association (AMA). Generally, CPT code changes are effective Jan. 1 annually, and ICD-10 code changes become effective Oct. 1 each year.

Stay informed by subscribing to updates and publications from the American Medical Association for changes to CPT codes, as well as the World Health Organization (WHO) and National Center for Health Statistics in the CDC, the organizations responsible for updating the ICD-10 and ICD-10-CM codes.

Continue boosting revenue with remote billing codes

Orthopedic surgeons can expand their potential for revenue by ensuring their staff applies remote therapeutic monitoring (RTM) codes.  

RTM is a form of telehealth that collects and evaluates data like the status of the musculoskeletal system and response to physical therapy. It’s low cost and enables providers to bill for additional services during the post-operative period without direct contact with patients or the use of equipment.

Learn more about using RTM billing codes to generate more revenue for your private practice by reading our article.

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Photo by Erol Ahmed