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Orthopedic Billing Tips to Keep Practice from Facing Costly Denials

September 4, 2018

Orthopedic Billing

Your medical billing processes are one of the most critical functions in your orthopedic practices. Proper orthopedic billing and coding process keep revenue flowing in with minimal delays, reducing cash flow problems and reducing stress for your practice. Denials can be one of the most significant issues orthopedics practices face and failing to take measures to prevent denials can be very costly for your practice. To minimize the risk of denials, here are several billing and coding tips your practice needs to follow.  Stay On Top of New Coding Updates 

Every year the American Medical Association (AMA) comes out with new changes to the Current Procedural Terminology (CPT) code set, and it’s important to make sure your practice stays current on the latest coding updates. If you’re doing your billing and coding in-house, then ensuring your billing and coding professionals educate themselves on the latest codes is essential. Keeping your coders up-to-date on recent coding changes may require an investment, but it’s worth it to make sure they’re current on codes so you have a smaller risk of denials. 

For example, the new ICD-10-CM code set that has just come out for the 2019 fiscal year has 279 additions, as well as 143 revised codes and 51 deletions. With significant changes coming out for the new fiscal year, it’s essential for orthopedic practices to get up to speed on these new codes as quickly as possible. 

Be Aware of and Avoid the Most Common Denials (duplicate claim, charge exceeds fee schedule)

It’s also important to make sure your orthopedic practice is aware of the most common claims denials so you can avoid them. One of the biggest reasons orthopedic practices face denials is for duplicate claims or services. Another common reason for claim denials is the charge exceeds the fee schedule. 

Make sure your office tracks the root causes of the most common denials. Then you can put processes into place to prevent these denials in the future. According to Becker’s ASC Review, some of the best actions you can take to avoid denials include:

  • Making sure that patient information is correct when it’s collected
  • Being diligent about insurance verification
  • Working with an automated billing service

Understand How ICD-10 and Recent Coding Changes Affect Orthopedic Coding

ICD-10 and recent coding changes affect every medical specialty, but they have significantly affected orthopedic coding. Some of the ways these changes affect coding for your orthopedic practice include: 

  • Laterality – While ICD-9 codes didn’t deal with laterality, you’ll find that ICD-10 code sets and newer CPT codes require that physicians document right, left, or bilateral for many different conditions, including fractures and joint disorders. 
  • Site Specificity – Many different diagnoses your orthopedic practice makes will require you to document the specific area of the body. For example, if you make a diagnosis of spinal stenosis or spondylosis, you’ll need to make sure that you indicate the specific spinal region or the claim will be denied. 
  • Place of Occurrence – ICD-10 and recent coding changes demand more specificity from orthopedic practices. Payers will require your office to provide documentation of where injuries occurred. 
  • Type of Encounter – Orthopedic physicians also need to make sure they are documenting with a level of specificity that ensures coders can understand whether the patient encounter was an initial one, subsequent encounter, or a sequela encounter. 

When Outsourcing is the Answer 

In many cases, deciding to outsource your orthopedic billing and coding can actually increase your revenue stream while decreasing costs for your practice. It often saves practices time with re-filing or appealing claims denials, which can be costly. If you’re looking for ways to increase revenues, maximize profitability, and lower your overhead costs, then outsourcing to a company skilled in orthopedic billing and coding may be the right choice for your practice. 

Click Here to Know More About M-Scribe Specialty Billing Services

If you’re ready to reduce denials and improve your revenue flow, M-Scribe can help. We offer billing and coding services to practices across the country, also specializing in payer contract review and provider credentialing. We’ll ensure that your practice is using the correct codes to maximize per code collection and reduce denials. Contact M-Scribe today to learn how we can help your practice improve your revenue cycle by reducing claims denials. 


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