Expert Guide to CMS 2024 Updates in Orthopedic Medical Billing
Navigating the complexities of orthopedic medical billing can be a challenging task, especially with the continuous updates from the Centers for Medicare & Medicaid Services (CMS).
For 2024, CMS has introduced a range of changes that directly impact orthopedic practices, from new codes for procedures like vertebral body tethering (VBT) to adjustments in evaluation and management (E/M) services.
CMS updates for 2024 are becoming headaches for healthcare providers, but it is important to stay on top of these updates to accurate billing, maintain compliance, and avoid costly errors.
In this blog, we will break down the key CMS 2024 updates in orthopedic medical billing and how they affect your practice, but before that let’s have a basic understanding of CMS.
Understanding of CMS in the Healthcare Industry
CMS stands for Centers for Medicare & Medicaid Services, a federal agency within the U.S. Department of Health and Human Services (HHS). CMS administers Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), along with enforcing health standards in long-term care facilities and hospitals.
In medical coding, CMS plays a critical role in maintaining healthcare coding guidelines, implementing regulations, and establishing payment structures. CMS updates include changes in coding practices, payment models, and regulations, impacting healthcare providers, especially when billing for services under Medicare and Medicaid.
The CMS 2024 Updates Related to Orthopedic Medical Billing
The orthopedic medical billing 2024 updates feature new codes for vertebral body tethering (VBT), bunion correction clarifications, and additional Category III codes.
Here are the key highlights:
1. The New Category I Codes (VBT) Codes:
The 2024 CPT code updates include four new codes for vertebral body tethering (VBT), a surgery used to treat adolescent idiopathic scoliosis without spinal fusion. VBT helps straighten the spine while still allowing it to grow.
During the procedure, the surgeon makes small cuts and places tiny screws along the curved part of the spine. A flexible cord is then passed through the screws. When the cord is tightened, it pulls the spine straighter.
- 22836: Anterior thoracic VBT (up to 7 segments)
- 22837: Anterior thoracic VBT (8 or more segments)
- 22838: Revision or removal of thoracic VBT
- 27278: Percutaneous sacroiliac joint fusion (replaces code 0775T)
2. New Category III codes are
CPT added a new code which is 0790T for replacement or removal of thoracolumbar or lumbar VBT.
The revised Category III codes include:
- 0656T: Anterior lumbar or thoracolumbar vertebral body tethering for up to 7 vertebral segments.
- 0657T: Anterior lumbar or thoracolumbar vertebral body tethering for 8 or more vertebral segments.
3. Bunion Correction Clarifications
In 2024, a small but important change was made to the codes 28292 through 28299, which are used for surgeries to correct hallux valgus (a condition where the big toe points outward, often accompanied by a bunion).
The change added an extra “with” in the description to clarify that these codes must include both the bunion removal and the hallux valgus correction.
For example, the updated description for code 28292 is: “Correction, hallux valgus with bunionectomy, with sesamoidectomy, when performed.”
This change was made because some coders were mistakenly using these codes for hallux valgus correction without bunion removal. By adding “with,” these surgeries should always include bunion removal.
Additionally, a note was added to codes 28297 and 28740 to prevent incorrect coding. If a first metatarsal cuneiform joint fusion (a type of bone fusion) is done without removing the bunion, coders should use code 28740 instead of 28297. This note helps ensure that the correct code is used based on whether or not the bunion was removed.
4. New Category III Code
The new code has been added 0814T – It’s for a procedure called percutaneous injection of calcium-based biodegradable osteoconductive material in the proximal femur, and it also includes imaging guidance.
This Category III code is used for reporting when a calcium-based material is injected into the upper part of the thigh bone (femur) to help form new bone. This is typically done for patients with conditions like osteoporosis. The procedure is done using imaging guidance to ensure accurate placement of the material
5. E/M Timing Changes
In 2024, updates clarify that the mid-point concept isn’t used for E/M services with a total time requirement. The office visit codes 99202-99205 and 99212-99215 now have a single minimum time that needs to be met for billing based on time, removing the previous range of codes. This change makes these codes consistent with other E/M codes but doesn’t change the time requirements.
6. New ASC-Payable Procedures
CMS has added 11 new surgical codes to the ASC payable list for 2024, which affect orthopedics medical billing:
- CPT 23470: Shoulder joint reconstruction
- CPT 23472: Shoulder joint reconstruction
- CPT 27006: Incision of hip tendons
- CPT 27702: Ankle joint reconstruction
- CPT 29868: Meniscal transplant in the knee with scope
These new codes will influence how orthopedic procedures are reimbursed
New Orthopedic Payment Model for 2024
A major change aimed at strengthening value-based treatment and boosting patient outcomes in orthopedics is represented by the new Orthopedic Payment Model for 2024. This approach encourages effective care coordination throughout the patient journey, from diagnosis to rehabilitation, and gives priority to bundled payments. Providers are encouraged to provide high-quality, reasonably priced treatment while cutting down on unnecessary operations, hospitalizations, and extended hospital stays.
This model has been influenced by CMS orthopedic payment models 2024, which have improved reimbursement standards and clarified quality parameters that have a direct effect on payment changes. CMS encourages orthopedic providers to embrace preventive care techniques and take a proactive approach to patient management by broadening the scope of bundled payments and enacting stronger regulations. Additionally, by streamlining documentation requirements, these modifications lessen administrative strain and free up doctors to concentrate on patient care. In the end, these changes are expected to improve orthopedic practices financial predictability, operational effectiveness, and patient outcomes.
Final Thoughts
To ensure accurate reimbursement you need to stay updated with the CMS updates.
But…Dealing with orthopedic medical billing and keeping up with CMS updates can be tough.
That’s why we are here to help you with expert medical billing and coding services just for orthopedic practices.
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