Orthopedic Coding Alert

Tip: Including an explanation in the op note will streamline your claim. When your orthopedist performs laminotomy and excision of herniated thoracic disc, you-ll find the only thoracic codes correspond to transpedicular or costovertebral approach. So what should you do? Turn to an unlisted code -- but make sure you follow these simple steps to show your carrier what to do with your unlisted-procedure claim. Step 1: Never Select a -Close but not Quite- Code You should never report a code that comes close to the procedure your orthopedist performed but doesn't quite fit. If no precise procedure or service code exists, you should report the service "using the appropriate unlisted procedure or service code," state the CPT "Instructions for Use" in the CPT manual. CPT includes unlisted-procedure codes to allow you to report procedures for which there is no specific CPT descriptor available. Payment for such claims, however, is not automatic. Your orthopedist must make a careful effort to document the procedure, and the information you include with your claim can make all the difference. Step 2: Explain the Procedure in Layman's Terms Any time you file a claim using an unlisted procedure code (for example, 27599, Unlisted procedure, femur or knee; or 29999, Unlisted procedure, arthroscopy), you should include a cover letter stating why you are using the unlisted procedure code, says Rebecca Lopez, CPC, coding specialist for Bright Health Physician's compliance department in Whittier, Calif. This separate report should explain, in simple, straightforward language, exactly what the physician did. Physician tip: "What I do is include a paragraph at the top of the op note explaining what the procedure was, why I used 29999, what code I compare it to, and so on," says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C. "This is the same as a cover letter but in the op note." Part of a coder's job when coding and preparing the claim is to act as an intermediary between the physician and the claims reviewer, providing a description of the procedure in layman's terms. You may even want to include diagrams or photographs to better help the person reviewing your claim understand the procedure. "When reporting unlisted procedures codes, I would suggest doing everything you can to make sure you get paid what you think is appropriate," says Denae M. Merrill, CPC-E/M, owner of Merrill Medical Management in Saginaw, Mich. "Overload the payer with information and always give them a way to contact you with questions," she adds. Why: Your payers will consider claims with unlisted procedure codes on a case-by-case basis, and they determine payment based on the documentation you provide. Unfortunately, claims reviewers frequently [...]