Orthopaedic Surgery Coding

View Sample Report: Orthopedic Coding Accuracy Audit

Orthopaedic Surgery Coding Services Overview:

The Coding Network considers Orthopaedic Surgery Coding to be four separate coding specialties: general orthopaedics coding (inculding sports medicine coding and total joint replacement coding,) spine surgery coding, hand/upper extremity coding, and foot-and-ankle surgery coding (podiatric surgery coding.) We believe that to be competent in coding for a subspecialty, the coder must do it every day. Consequently, we require our orthopaedic surgery coders to focus only on orthopaedic surgery; we don’t even allow them to code the E&M services provided by our orthopedists. All of our coders live-and-work in the United States. Each of our orthopaedic surgery coders must have a minimum of three years of orthopaedic surgery coding experience and must pass our very demanding proficiency tests for those orthopaedic coding subspecialties. We have a separate test for each orthopaedic surgery coding specialty. Unlike the basic coding certification tests which are largely multiple choice questions, our specialty-specific coding proficiency tests are actual de-identified operative reports from our tertiary orthopaedic surgery subspecialists. The few who pass must demonstrate an accuracy rate of at least 95% on our ongoing random Quality Assurance/Continuous Accuracy Improvement reviews in order to continue working for The Coding Network.

Compare The Coding Network’s approach to quality to the majority of our competitors, both domestic and in off-shore “third world” countries; their business model is to offer would-be coders a vocational “trade school” experience designed to prepare them for the certification test. Once they pass, they are placed within that company to code for you. It’s the equivalent of having an intern perform brain surgery!

Many surgeons believe that nobody knows better than he/she what was done in the operating room, “so I’m the best one to code it.” The first part of that sentence is correct, but does not logically lead to the correct conclusion. Coding is dynamic; does that surgeon know that just the 2010 NCCI data set includes 24,060 new active pairs and 19,083terminated pairs (237 were terminated retroactively to 1/1/09) and 869 modifier changes, and 5,299 swapped pairs? The 2010 CPT expanded the Musculoskeletal System subsection to include new guidelines defining excision of subcutaneous, fascial, and subfascial soft tissue tumors and radical resection of both soft tissue and bone tumors codes. It includes 41 new codes, 53 revised codes, 7 deleted codes, and new parenthetical notes and orthopaedic surgery procedural coding instructions. To make orthopaedic surgical coding even more complicated, the AMA decided to assign CPT code number that are not sequential with some “families” of codes. That doesn’t even touch the many annual and quarterly changes to the ICD-9 coding system. Coding can not be cavalierly considered as simply an “afterthought” to performing an operation. Like being an orthopedist, orthopaedic surgery coding is a career of its own.

The Coding Network’s Orthopaedic Surgery Coding Division

  • Directed by a nationally known surgical coding expert.
  • Decades of experience in orthopaedic surgery coding for academic and private practices.
  • Team of certified orthopaedic surgical coders each with a focus on orthopaedic subspecialties.
  • Experience in coding for orthopaedic surgeons in 49 states.

Surgical Coding Needs

  • Well trained orthopaedic surgery specialty coders are difficult to find, expensive to recruit, and their ongoing “care and feeding” can be quite costly.
  • Few certified coders have the extensive orthopaedic surgery coding experience and specialty knowledge possessed by The Coding Network’s staff of orthopaedic surgery coding experts.
  • Orthopaedic surgery coding, particularly spine surgery, is among the most complex coding of all. It presents a unique set of challenges with levels, interfaces, vertebrae, and instrumentation that are totally unlike any other subspecialties.
  • Coder turnover creates cash flow peaks-and-valleys.
  • Smaller orthopaedic practices can not always cost-justify a full time certified coder. They are an expensive overhead item who often use their highly paid time on other less-challenging non-coding tasks.
  • There is no such thing as a “mulligan” when submitting Medicare and insurance claims. They must be accurate the first time. The legal and financial risks of upcoding or undervaluation are enormous.

TCN’s Orthopaedic Surgery Coding Solution

  • The Coding Networks surgical coders are “black belts” in each individual subspecialty within the entire spectrum of orthopaedic surgery coding. We offer you coders specializing in:
    • General Orthopaedic Surgery Coding, including Sports Medicine, and Total Joint Replacement.
    • Orthopaedic Spine Surgery Coding.
    • Hand and Upper Extremity Surgery Coding.
    • Foot-and-Ankle (Podiatric) Surgery Coding.
  • 2-to-3 business day coding turnaround via HIPAA + HITECH compliant secure email, overnight courier, or fax. We can remotely dial into your electronic medical record or transcription service’s archives.
  • HIPAA and HITECH compliance and no documents are sent off-shore.
  • Our per-case pricing model is inexpensive and our team of coders stabilizes cash flow. You only pay for what you need. Never worry about revenue cycle “whiplash” caused by absences, vacations, family leaves, etc.
  • No monthly minimums gives you total control.
  • Volume-driven pricing makes us an ideal ongoing solution for practices of all sizes.
  • Identification and feedback of documentation deficiencies at no additional cost.
  • A practical and cost-effective solution for your orthopaedic surgery coding needs.
  • No monthly minimums.

Services

  • Ongoing day-to-day coding.
  • Temporary orthopaedic surgery coding to cover vacations, medical leaves and employee turnover.
  • Backlog coding resolution services.
  • Coding accuracy audits with user friendly and educational report formats to identify both compliance exposure and missed revenue opportunities.
  • Documentation training services with subspecialty workbooks..
  • Coding “helpline” services.
  • RAC and OIG audit defense.

Latest Blog Posts:

  • wachler-associates

Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

September 5th, 2017|Comments Off on Under Michigan’s New Medicare RAC Regime, Physician Services Are the Initial Primary Target

An announcement came back in back in October 2016 from the Centers for Medicare & Medicaid Services (CMS). It announced that it had awarded to various entities the next round of contracts to serve as […]

  • GenericFraudHFN_27

Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million

September 1st, 2017|Comments Off on Civil Fraud Case Settlement from Fredericksburg Hospitalist Group amounts to $4.2 Million

Along with 14 of its member shareholders, Fredericksburg Hospitalist Group has agreed to pay nearly $4.2 million to settle a federal False Claims Act case brought under the qui tam whistleblower provisions of the FCA.

Read […]

  • 2745

Medical Practice Agrees To Resolve Allegations Of Overbilling Medicare

August 28th, 2017|Comments Off on Medical Practice Agrees To Resolve Allegations Of Overbilling Medicare

St. Agnes Healthcare in Baltimore, Maryland has agreed to pay the United States a sum of $122,928 to resolve issues under the False Claims Act. These allegations allege that they submitted false claims to Medicare […]

  • 0120_Healey

Due to Improper Billing, Healey Returns $500,000 in Settlement With a Springfield Dentist

August 25th, 2017|Comments Off on Due to Improper Billing, Healey Returns $500,000 in Settlement With a Springfield Dentist

Massachusetts Attorney General Maura Healey announced today a settlement with a pediatric dentist in Springfield. Healey’s office returned $500,000 to MassHealth, the state’s Medicaid program, resolving claims that improper billing for services occurred.

Read the full […]