Understanding Medical Billing Codes for Orthopedic Procedures

Ever wonder, how healthcare practitioners communicate with insurance companies for timely reimbursement? 

Well, this is where medical billing and coding play an important role.

This crucial process allows healthcare providers to communicate the specific services and procedures they perform using standardized codes. These codes are universally recognized by insurance companies and regulatory bodies, ensuring clarity and accuracy in the reimbursement process. For orthopedic practitioners, understanding and correctly using these billing codes is essential for maintaining compliance and minimizing claim denials.

This blog will provide an overview of some common orthopedic medical billing codes, helping healthcare practitioners better understand how to use them effectively.

Overview of Orthopedic Medical Billing Codes

Orthopedic medical billing codes help describe the diagnosis, procedures, and services provided to patients during their care. These codes are part of the Current Procedural Terminology (CPT) system and the International Classification of Diseases (ICD-10). Proper coding not only ensures that the procedures are accurately billed but also minimizes the risk of claim denials.

Common Billing codes for orthopedic services

Orthopedic practices frequently use a set of alphanumeric codes for services such as joint injections, fracture repairs, and imaging studies. Understanding the most common codes can significantly enhance billing accuracy.

Each code precisely describes a specific service or procedure, enabling standardized communication between healthcare providers, insurers, and other entities involved in billing. Proper use of CPT codes ensures accurate documentation of services, representing the care provided and streamlining the orthopedic medical billing process.

Here are some common orthopedic medical billing codes

• E/M or Evaluation and Management: 99201 – 99499
• Anesthesia: 00100 – 01999; 99100 – 99140
• Radiology: 70010 – 79999
• Medicine: 90281 – 99199; 99500 – 99607
• Pathology and Laboratory: 80047 – 89398
• Surgery: 10021 – 69990

Medical Billing Codes 72040, 72070, and 77002 Explained

The orthopedic medical billing codes 72040, 72070, and 77002 are commonly used in orthopedic care for diagnostic imaging and procedural guidance. These codes represent specific radiologic exams and fluoroscopic guidance, crucial for diagnosing and treating spinal issues and other orthopedic conditions. 

Understanding their proper use ensures accurate billing and efficient patient care.

• 72040:- This code is used when the radiological examination.
• on is conducted for the spine and cervicals; anteroposterior and lateral.
• 72070:- This code applies to a thoracic spine radiologic examination with two views, typically used for diagnosing issues in the middle back.
• 77002:- Fluoroscopic guidance (77002) is used when placing a needle for a procedure such as a biopsy or injection. It is common in procedures involving joint or spine treatments.

Understanding Billing Code 64490 for Orthopedic Aftercare

Code 64490 is used when injecting medicine around the facet joints in the neck (cervical) or upper back (thoracic) to either find the source of pain or relieve it. Facet joint interventions, whether diagnostic or therapeutic, must be performed with fluoroscopic or CT guidance, which is included in CPT codes 64490-64495. Therefore, separate billing for guidance codes (e.g., 77001-77003, 77012) is not allowed. 

CPT codes 64490-64495 should be reported once per level, per side, regardless of needle placements. For bilateral injections at the same level, use modifier -50. 

For additional bilateral injections on the same day, use add-on codes 64491 (cervical/thoracic) or 64494 (lumbar/sacral) with modifier -50.

Using modifiers RT, LT, or -59 is incorrect and will result in claim denial. Prior authorization may be required based on the patient’s benefit plan and applicable laws.

What is Medical Billing Code 20930 Used For?

The billing code 20930 is used for bone grafting procedures. Specifically, it covers the insertion of bone grafts for spinal surgeries, including fusion procedures. This helps stabilize the spine and supports the healing process in complex back surgeries.

When billing for CPT code 20930 (Sp bone algrft morsel add-on), using the correct modifiers ensures accurate reimbursement and compliance.

Here are key modifiers:

• Modifier 59 (Distinct Procedural Service): Indicates the bone graft procedure is separate from others on the same day, preventing bundling issues.
• Modifier 51 (Multiple Procedures): Used when multiple procedures occur during the same session, though 20930 is usually exempt.
• Modifier 76 (Repeat Procedure by Same Physician): This applies if the procedure is repeated by the same doctor on the same day.
• Modifier 77 (Repeat Procedure by Another Physician): Used when a different doctor repeats the procedure on the same day.
• Modifier 78 (Unplanned Return to OR): For unplanned related procedures during the postoperative period.
• Modifier 79 (Unrelated Procedure During Post-op Period): For unrelated procedures by the same doctor during the post-op period.
• Modifier 22 (Increased Procedural Services): Indicates the procedure required more work than usual.
• Modifier 62 (Two Surgeons): Used when two surgeons work together on distinct parts of a procedure.
• Modifier 66 (Surgical Team): For procedures requiring a team of surgeons.
• Modifier 99 (Multiple Modifiers): Applied when multiple modifiers are needed.

CPT 20930 is an add-on code used with primary spinal procedures for Medicare reimbursement. It cannot be billed alone and must be supported by a medically necessary primary procedure. Reimbursement varies by location and Medicare contractor.

Wrap Up

Understanding the complexity of orthopedic medical billing can ensure accurate reimbursement for healthcare practitioners. However, improper use of medical codes like 72040, 72070,  64490, and 20930 leads to claim denial and revenue loss for organizations.

“As per the survey, the average claim denial rate in the US healthcare industry typically ranges from 5–10%, though it can vary widely depending on the healthcare provider and payer.”

If you don’t want to fall into this range, consider outsourcing medical billing to an agency like EZ Settle Solutions. 

We at EZ Settle Solutions look after your revenue cycle management while you are handling patients. Our expert medical coder ensures compliance and maximizes your reimbursement. 

Contact us today to learn how we can simplify your orthopedic medical billing process and improve your practice’s efficiency!

Get started free consultation with EZ Settle Solutions!

Contact us at  346-335-4093 / info@ezsettlesolutions.com or schedule a free consultation to learn more about how we can assist you.