Coding

Similar to other specialties, orthopedic coding has its challenges. Coding denials can be common in orthopedics and often are a result of poor documentation. The best practice is to code based on documentation, not reimbursement, which can cause issues when doctors are not documenting thoroughly. Many providers fail to document key pieces of information, which can interfere with the orthopedic billing process and result in missed revenue opportunities. Medical coding guidelines are constantly changing, as are payor guidelines, and many doctors and internal teams struggle to keep up. Holding regular education sessions for not only professional coders and billers but also for providers is crucial. 

Coronis Health can make sure your practice is ready for ICD-10 with certified coders and professional orthopedic medical billing experts. Our certified coders work with advanced coding software and perform regular audit checks to reduce denials and improve your revenue cycle management. Understanding how to apply standard CPT, ICD-CM diagnosis coding, and supply codes that follow CMS guidelines is essential when providing expert coding services.

Just like with other specialties, medical billing codes for orthopedic services differ according to criteria set in the ICD-10-PCS. Using these specific codes, medical billing specialists can bill the proper procedures to a patient’s insurance company, creating a more unified system of billing and coding.

There are many different types of medical specialties that require specific coding for billing and even within certain specialties, there can be different medical billing codes depending on the actual procedure.

For orthopedic procedures, medical billing services vary based on what type of procedure is being performed. In general, orthopedics deals with issues with the musculoskeletal system, which includes the bones, tendons, ligaments, and/or muscles. The coding can differ depending on which portion of orthopedics under which the procedure falls. For example, medical billing for custom orthotics in pediatric orthopedics will require different coding services than for an orthopedic practice performing multiple procedures for adults.

Tendon & Ligament Procedures

Different still are the procedures of the tendons and ligaments, such as a PLC reconstruction. Repair procedures for those parts, which typically require submitting orthopedic surgery claims, would begin “0L” and “0M,” respectively. This includes:

• The code for a tendon repair in the right lower arm could be coded as one of the following: 0LQ50ZZ, 0LQ53ZZ, or 0LQ54ZZ, depending on the approach being used.
• The code for a ligament repair to the right lower arm could be coded as one of the following: 0MQ50ZZ, 0MQ53ZZ, or 0MQ54ZZ.

Character Designation

For procedures, the character structure is as follows:

1. The first character designates the section in which the procedure falls in the ICD-10.
2. The second character denotes the body system that is being affected by the procedure.
3. The third character is determined by the root operation (main objective) of the procedure.
4. The fourth character is established as the character that specifies which body part is being affected by the procedure.
5. The fifth character defines the approach of the procedure.
6. The sixth character outlines the device being used.
7. The seventh character provides any other qualifying information pertinent to the procedure in order to make the coding process as simple as possible.