Medical Coding for Orthopedics

No matter how orthopedic specialists describe their specific practice, general orthopedic surgeon, orthopedic surgeon specialist, or general orthopedic surgeon with a specialty interest, coding demands relative to this specialty field are defined by a need for well-informed, refined skills which are extremely perceptive in nature. The medical coding services that PDN provides meet the highest demands of such a specialty.

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The scope of any orthopedic practice revolves around injuries, congenital deformities or abnormalities, and diseases concerning the musculoskeletal system which calls for a mastery of field specific terminology, anatomy, and pathophysiology in order to competently render the most accurate and relevant data related to each and every procedure, diagnostic measure, and evaluation.

Correctly interpreting information and applying proper codes, modifiers, and extensions serves to help create and maintain a proper revenue stream for the practice by eliminating claim rejections and denials. Orthopedic specialist coders provide an invaluable service in terms of assuring regulatory compliance and an exemplary work product that conforms to the guidelines put forth by CMS (Centers for Medicare and Medicaid Services).

A superior understanding of the ICD-10, and the many ways in which the new requirements and coding changes impact orthopedics, is another area in which a professional coder excels. The implementation of ICD-10 brought with it 264 new codes, 143 deleted, and 134 revised codes that apply to coding for an orthopedic practice. This is in addition to new rules related to modifier 59 and the introduction of the applicable modifiers XU, XE, XP, and XS. There are also changes with regard to the way that injuries and diseases are classified, a new focus on laterality, and revisions to relevant terminology. Noted required documentation specifics: Laterality, site specificity, encounter type (initial, subsequent, consulting, operative, post-op), combination codes (there are only a few combination codes utilized in orthopedic procedures, i.e. M54.4 lumbago with sciatica), and place of occurrence codes.

Common orthopedic coding errors include providing the wrong extension codes, confusing an upper case letter O for the numeric 0, confusing a lower-case l for the numeric 1, incomplete codes, and relying on software to identify procedure-based codes rather than accurately coding based on a comprehensive knowledge of the proper codes, modifiers and extensions related to specific visits and procedures.

Certified orthopedic coders possess superior skill-sets which distinguish them as stand-outs within their profession:

  • Unparalleled ability to accurately document and code for office visits, consultations, and procedures including appropriately integrating diagnosis and treatment.
  • Comprehensive knowledge base which allows coders to correctly interpret, summarize, and communicate physician notes and patient outcomes, as well as establish a well-documented chain of services across the patient’s claims history.
  • ICD-10- proficiency.
  • Competency with regard to electronic medical records, procedures, and evaluation management documentation.

PDN’s orthopedic coding specialists provide accurate, consistent, and compliant results which help physicians maintain reliable revenue streams while preventing claim rejections and denials. Our professional coders allow practitioners to concentrate on the business of attending to the needs of their patients without the worry of claim submissions and regulatory compliance. PDN offers a wide range of highly beneficial services which can also take the stress out of office management, and provide needed support for additional training and education for staff members.