Orthopedic Medical Billing Aftercare: Proper Billing and Coding Practices
Surgery and diagnosis are not the only things where practitioners’ jobs end, aftercare after successful surgery is also vital. Providing quality care after an orthopedic procedure is a time-consuming process. However, it comes with lots of worries – ensuring accurate orthopedic medical billing and coding for aftercare services is equally important.
Improper billing for aftercare can lead to difficulty in revenue cycle management, which eventually impacts your revenue.
At EZ Settle Solutions, we know how much it is to consider aftercare in Orthopedic medical billing. Therefore, we have come up with a guide.
In this guide, we will walk you through the essential billing practices for orthopedic aftercare, so your claims are processed smoothly, and you receive the maximum reimbursement.
1. Importance of Accurate Aftercare Billing
Orthopedic aftercare involves follow-up visits, monitoring healing, managing orthotic devices, and ensuring the patient’s full recovery. Orthopedic medical Billing for these services requires precision. Errors in coding or using outdated CPT codes can delay payments or result in claim denials. This is why it’s crucial to understand the coding requirements for every aspect of orthopedic aftercare, ensuring compliance and preventing unnecessary losses.
2. Codes for Orthopedic Aftercare
A. ICD-10 Codes
ICD-10 coding for orthopedic aftercare uses specific codes to reflect the phase and type of care. For acute injuries, including fractures, Chapter 19 codes permit seventh characters. When using a seventh character “D,” you are indicating that the patient is in the recovery or healing phase, signifying ongoing aftercare for the injury. Thus, it’s important to avoid pairing aftercare codes with injury codes, as this creates redundancy.
ICD-10 Z codes are used for post-operative care, chronic symptoms, surgical aftercare, and continued recovery. These codes are assigned when patients need ongoing care during their recovery. However, injury codes should not be combined with aftercare codes to avoid duplication.
Key ICD-10 Codes for Orthopedic Aftercare:
- Z47: Orthopedic aftercare
- Z47.1: Aftercare following joint replacement surgery
- Z47.2: Encounter for removal of the internal fixation device
- Z47.3: Aftercare following explantation of joint prosthesis
- Z47.31: Following explantation of shoulder joint prosthesis
- Z47.32: Following explantation of hip joint prosthesis
- Z47.33: Following explantation of knee joint prosthesis
- Z47.8: Encounter for other orthopedic aftercare
- Z47.81: Following surgical amputation
- Z47.82: Following scoliosis surgery
- Z47.89: Other specified orthopedic aftercare
These codes allow for accurate documentation and reimbursement for orthopedic aftercare, ensuring that claims reflect the stage and nature of the patient’s recovery.
B. CPT Codes
CPT codes specifically for orthopedic aftercare vary depending on the nature of the visit or treatment. For example, codes related to wound care, device adjustments, and post-operative assessments must be chosen carefully to match the services provided.
- 99024 for follow-up visits included in post-op care.
- 97001 and 97002 for physical therapy evaluations and re-evaluation.
Accurate use of these codes ensures that your practice receives reimbursement for the full scope of aftercare services provided.
How to Bill for Orthotic Devices and Repairs
Orthotic devices, such as braces or supports, are often used in orthopedic aftercare to aid patient recovery.
Orthopedic medical billing for these devices, as well as any repairs, requires careful attention to detail.
1. Obtain Physician’s Prescription
Ensure there’s a valid prescription for new orthotic devices or repairs.
2. Use Correct HCPCS Codes
Accurate HCPCS coding is essential for orthotic billing. Use specific codes for the device or repair service.
For Example
- Repair of Device
L4205: Repair of orthotic device, labor component, per 15 minutes.
- Replacement of Parts (L4210)
Use L4210 for minor replacement parts (e.g., screws, straps) with side modifiers (RT, LT) and RB (replacement part) as required.
- Orthotic Replacement
Replacement is covered for loss, theft, or disasters, not wear and tear. Documentation should include circumstances, a new physician order, and an RA modifier to denote replacement.
3. Apply Relevant Modifiers
Use modifiers to clarify the service:
- NU: New Equipment.
- RR: Rental.
- RP: Repair and Replacement.
Modifier Accuracy is essential to avoid claim denials.
4. Submit Required Documentation
Include a detailed repair description, factory invoices, and a Certificate of Medical Necessity (CMN) if necessary.
5. Use the CMS-1500 Form
Submit claims using the CMS-1500 form, ensuring all details are complete and accurate.
6. Medicare Coverage for Repairs
Medicare covers repairs essential for functionality, not luxury upgrades or costly repairs.
Each step ensures accurate Orthopedic Medical Billing and maximizes reimbursement for orthotic device services.
Avoid the hassle of orthotic billing errors. EZ Settle Solutions has specialists ready to manage your orthopedic medical billing needs. Get in touch to learn more about how we can help.
Understanding CPT Codes for Follow-Up Visits
Follow-up visits are critical for monitoring recovery post-surgery. CPT codes for these visits, such as 99024, cover the patient’s follow-up care, but additional services such as x-rays, physical therapy, or new treatments may require additional codes. Ensuring that all relevant procedures are documented and billed accurately prevents revenue leakage and maximizes reimbursements.
Billing Code 64490: What You Need to Know
CPT code 64490 is used for diagnostic and therapeutic nerve blocks, a procedure often needed during follow-up orthopedic aftercare to manage post-surgical pain. These facet joint injections, whether diagnostic or therapeutic, must include fluoroscopy or CT guidance, as covered in CPT codes 64490-64495. Therefore, orthopedic medical billing separate guidance codes (e.g., 77001-77003, 77012) are not permitted.
Key Guidelines:
- Single Level, Per Side: Report CPT codes 64490-64495 once per level, per side, regardless of the number of needle placements.
- Bilateral Injections: For bilateral injections at the same level, use modifier -50.
- Additional Injections: For same-day additional bilateral injections, use add-on codes 64491 (cervical/thoracic) or 64494 (lumbar/sacral) with modifier -50.
- Incorrect Modifiers: Using RT, LT, or -59 is incorrect and will result in claim denials. Verify if prior authorization is necessary based on the patient’s insurance plan and applicable regulations.
Understanding how and when to apply this code is crucial, as it must be billed correctly to ensure reimbursement for these specialized pain management services. Detailed documentation, including the patient’s diagnosis and the necessity for nerve block treatment, helps support the claim.
Don’t let complex codes like 64490 cause delays in your orthopedic medical billing cycle. Let EZ Settle Solutions handle your orthopedic aftercare billing for faster, more accurate reimbursements.
Conclusion
Orthopedic aftercare billing requires expertise and precision, as small errors can lead to claim denials and lost revenue. By using the correct CPT codes, maintaining detailed documentation, and ensuring that follow-up services are properly billed, your practice can avoid these challenges. Partnering with a professional medical billing agency like EZ Settle Solutions ensures that your orthopedic medical billing is handled efficiently, so you can focus on patient care.
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Contact EZ Settle Solutions today for expert assistance and start improving your practice’s financial health!
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