Hand Surgery Coding Basics
Hand surgery coding plays an important role in accurately determining the procedure performed and quantifying the amount of work done by the surgeon. American Medical Association (AMA) updates and maintains the Current Procedural Terminology (CPT) codes applicable to hand surgery coding. The CPT code range for surgical procedures on the hand and fingers is 26010-26989. Despite the importance of accurate hand surgery coding, studies find that billers and surgeons are often unaware of proper billing codes. Surgeon compensation structures may influence patterns in the coding of procedures. Coding errors, whether due to fraudulence or inaccuracy, can lead to substantial fines and civil penalties by the Department of Health and Human Services. In this article, we discussed common hand surgery coding mistakes and avoiding them could help your orthopedic practice to gain accurate reimbursement and stay compliant in payer audit.
Common Hand Surgery Coding Mistakes
1. Up-coding and Un-bundling
Poor coding practices, including up-coding and unbundling, are forms of coding fraud and can have detrimental effects on orthopedic practices. Up-coding refers to submitting a CPT code for a procedure of higher reimbursement value than the actual procedure performed and is an unethical violation by CMS guidelines. Conversely, down-coding refers to coding at a lower level than the services provided and is often done due to fear of external payer audits. Unbundling is the coding of procedures separately when they have a shared code. Although the surgeon is not always responsible for the coding of procedures, he or she is ultimately liable for violations. For this reason, surgeons delegating this task must review coding for their patients to prevent violations.
2. Defining Location Specificity
Current Procedural Terminology (CPT) includes references to specific locations in the forearm, wrist, hand, and fingers for reporting flexor and extensor tendon repair codes. Coders often makes mistake of selecting codes based on the site of tendon insertion and not on the location of the repair. In particular, zone 2 flexor tendon repairs in the hand are important, as a separate CPT code is used to describe such procedures. Location specificity also is essential in fracture management reporting. An example is distal radius fractures, which require documentation of whether the fracture is extra- or intra-articular. If intra-articular, the operative note must specify the number of fragments (one to two or three or more). Be consistent when creating the operative note procedure list and documenting operative detail within the note body.
3. Higher Value wRVU
In contrast to salaried surgeons, surgeons subject to the collections or wRVU model have more to gain financially from using additional codes and selecting higher-valued RVU procedures. Recent survey found that 23 percent surgeons increased the procedures and tests offered or the time spent with the patient in order to maximize profits. Productivity-based compensation (wRVU) always encouraged higher rates of procedures.
4. CPT Codes 64718 and 24305
CPT code 64718 is used to describe Transposition and/or neuroplasty of the ulnar nerve at the elbow. This code is used commonly to report simple decompression of the ulnar nerve, such as anterior transposition or subcutaneous transposition. Instead, surgeons may perform a submuscular transposition, which also is reportable as 64718. If the physician performs tendon lengthening as a component of the submuscular transposition, a secondary CPT code may be reportable: 24305, Tendon lengthening, upper arm or elbow, each tendon. Because there is no NCCI edit between codes 24305 and 64718, it is not necessary to use modifier 59 for this code combination.
5. Separately Coding for Debridement
Debridement is considered a separate procedure only when gross contamination requires prolonged cleansing, when appreciable amounts of devitalized or contaminated tissue are removed, or when Debridement is carried out separately without immediate primary closure. For example, separate reporting of Debridement from the 11042–11047 series of CPT codes would not be allowed in conjunction with an open wound with a tendon laceration, unless the criteria above are met and well documented in the operative report. CPT does allow separate reporting of excisional Debridement from the 11010–11012 series of CPT codes in conjunction with open fractures or dislocations with appropriate documentation of medical necessity.
As mentioned earlier, poor coding practices could have detrimental effect on any orthopedic practice. You must seek help from expert orthopedic coders for accurate orthopedic coding. Legion Healthcare Solutions is a leading medical billing company providing complete orthopedic billing and coding services. To know how you can avoid common hand surgery coding mistakes and to know more about our orthopedic billing services, contact us at contact us at 727-475-1834 or email us at email@example.com