Common orthopedic coding errors

Coding denials can be common pitfalls for an orthopedic group that tie up valuable time and impact cash flow. Below you’ll find the most common coding errors and the appropriate way to address them.

Coding Errors:

1. 1. Code Unbundling:
      1. i) Inappropriately coding the component parts of a procedure instead of reporting the procedure using a single code.

Example:  Knee bundling:  AAOS and CMS recognize three (3) compartments to the knee: Medial, lateral and suprapatellar.  You cannot unbundle surgical procedures performed in the same compartment.

1. b)  Fracture Care:  Knowing the definition of the L codes vs. Q codes for casting or

Strapping

Example:  When using Pre-fabricated or off-the shelf splint or brace use the L series of codes. Refer to casting and strapping codes only when the provider custom fabricates the cast / splint using fiberglass, plaster, etc.  The supplies used for custom castings are generally reported with Q codes.

1. c)   Injections:
2. i) Frequency; most injections work for weeks or months, repeat injections may

deny if administered in a short time span.

1. ii) Imaging guidance use with injections:

Require documentation for imaging guidance necessity:  documentation

the initial attempt failed, the patient’s condition would not allow the

injection to be performed without the imaging guidance.

iii)   Monitor J codes (J7324, J7325, J7327, J7318) and correct unit billing

If coding is a challenge for your orthopedic practice, Coronis is here to help.