Orthopedic Coding Alert

Watch out: Multiple providers sometimes necessitate modifiers. You can sail through coding for trauma cases -- and get your claim submitted first, if you follow these insider tips. Although reports and information must arrive in the coding department before coding can begin, time is critical in trauma cases due to third party liability. There are cases of first claim in is first -- and sometimes the only -- claim paid. To expedite the filing process, you must ensure that there are policies or protocols in place to take care of these issues. Don't forget: Accuracy with the information is critical. Know Your Orthopedic Trauma Coding ABCs The coding of orthopedic trauma involves many systems. First, coders must have accurate, complete, and detailed information in the operative report. Otherwise, charges will be lost. Therefore, physician documentation is critical. What to do: Educate your physicians about the details you need. Ensure that each anatomical site is clearly identifiable in the report and that each injury is well documented. Pitfalls: Many times people create reports with documentation that runs together and there is no clear indication as to where one wound ends and another begins. In addition, sometimes so much emphasis is placed on the "primary" injury that incidental injuries become lost in the haze of poor documentation. Often, there are codes in the integumentary system that never make their way into the claims. Remember: You should never code from the "procedure line." As orthopedic coders, we are all familiar with the debridement codes 11010-11012. These codes represent the debridement associated with fractures. CPT Assistant (March 1997) states the following: "They [11010-11012] are intended to address treatment of a number of injuries that require extensive preparation in order to adequately repair a wound site, including both open and closed fractures, and usually involve numerous layers of flesh and bone." The article goes on to say, "Some closed fractures may have associated skin contusions, deep abrasions, burns, and cutis separation from subcutaneous tissues (separation of the skin layers), [and] may require fracture debridement." Watch out: Payers may be reluctant to pay 11010-11012 for closed fractures. The above excerpt supports the coding of a closed fracture debridement. Again, your ability to collect depends on the documentation. The additional work must be evident in the documentation and the additional procedure must be medically necessary. Avoid Common Debridement Errors Wound debridements (11041-11044) are often miscoded or undercoded. The physician may mention the debridement but not document well enough the debridement's depth or its specific location. Action: In these cases, you have only two options: 1. Hold the claim until you can clarify the procedure with the provider. 2. Code the lowest level of debridement. Doctors- offices also often overlook coding [...]