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Orthopedic Coding Alert

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Wrong Spinal Level Can Mean No Reimbursement Whatsoever

Published on Tue Mar 03, 2009

Here's what to do if wrong location is due to extra vertebrae. If your orthopedic surgeon performs a procedure on the wrong spinal level, you should hold off seeking any payment from Medicare. Future transmittals will instruct payers how to implement three final national coverage decisions (NCDs) specifying non-coverage. As of Jan. 15, CMS specifies they will not cover surgical or other procedures when the MD performs: - a procedure on the wrong body part; - a procedure on the wrong patient; or - the wrong procedure. Bottom line: If you bill for procedures that meet any of the above stipulations and receive reimbursement, you could be facing a recoupment request at some future date. "Hopefully this will force providers, OR staff, and other staff involved with the patient to take appropriate actions and verify they have the correct patient, the correct anatomical location, and are performing the correct procedure(s)," [...]
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