Medical Billing for Orthopedic Surgery

Medical Billing for Orthopedic Surgery

MPMR has been providing premier medical billing services for orthopedic surgeons for over two decades. There are considerable nuances to successful billing for orthopedics, which MPMR has mastered.Medical Billing for Orthopedic Surgery

In order for an insurance company to pay for any procedures performed by a healthcare organization, billing codes must be put into place. Billing codes are established by the ICD-10 which has a code book for procedures, diagnosis, and drugs used in the treatment of patients. These codes contain seven alphanumeric characters that correspond to different aspects of a treatment.

Character Designation for Orthopedic Procedures

Orthopedic Surgery Medical BillingFor procedures, the character structure is as follows:

  1. The first character designates the section in which the procedure falls in the ICD-10.
  2. The second character denotes the body system that is being affected by the procedure.
  3. The third character is determined by the root operation (main objective) of the procedure.
  4. The fourth character is established as the character that specifies which body part is being affected by the procedure.
  5. The fifth character defines the approach of the procedure.
  6. The sixth character outlines the device being used.
  7. The seventh character provides any other qualifying information pertinent to the procedure in order to make the coding process as simple as possible.

Billing for Orthopedic Procedures

There are many different types of medical specialties that require specific coding for billing and even within certain specialties there can be different billing codes depending on the actual procedure.

For orthopedic procedures, the billing varies based upon what type of procedure is being performed. In general, orthopedics deals with issues with the bones, tendons, ligaments, and/or muscles. The coding can differ depending on which portion of orthopedics under which the procedure falls.

  • Ulnar Bone Repair – If a patient must have his or her ulna repaired from a fracture, the code could be any of the following: 0PQK0ZZ, 0PQK3ZZ, 0PQK4ZZ, or 0PQKXZZ. Note that the only
    Orthopedic Billing

    Distal Humerus Fracture Repair

    difference between all these codes is in the fifth character, which marks the approach to repairing the ulna. Every other character stays the same. The “0” represents a medical procedure, and the “P” specifies that it is a procedure having to do with the bones of the upper body. The “Q” indicates that it is a repair, and the “K” specifies that it is a repair of the ulna. The “ZZ” at the end reveals that there is no device being used to reset the bone and no other qualifying information needed in this instance.

  • Ulna Muscle Repair – If the patient had to repair a muscle in the same area, the coding would look more like this: 0KQ90ZZ, 0KQ93ZZ, or 0KQ94ZZ. The “0” still denotes that it is a medical procedure, but this time instead of a procedure affecting the bones in the upper body, the system being affected is the muscle (K). The “Q” still indicates that it is a repair, but the “9” in place of the “K” from the previous repair indicates that it is a repair of the muscles of the lower arm region. This is less specific than the previous code. And, again, the fifth character differs depending on the approach being used in the procedure. The codes still end with “ZZ” indicating that there is no device being used and no other qualifying information needed.

Tendon and Ligament Procedures

Different still are the procedures of the tendons and ligaments. Repair procedures for those parts would begin “0L” and “0M,” respectively. This includes:Medical Billing Neurology

  • The code for a tendon repair in the right lower arm could be coded as one of the following: 0LQ50ZZ, 0LQ53ZZ, or 0LQ54ZZ, depending on the approach being used.
  • The code for a ligament repair to the right lower arm could be coded as one of the following: 0MQ50ZZ, 0MQ53ZZ, or 0MQ54ZZ.

 

 

Conclusions

Just like with other specialties, billing codes for orthopedic procedures differ according to criteria set forth in the ICD-10-PCS. Using these specific codes, medical billing specialists can bill the proper procedures to a patient’s insurance company, creating a more unified system of billing and coding.

MPMR can make sure your practice is ready for ICD-10 with several certified coders and orthopedic medical billing specialists. Call MPMR for a complimentary consultation to find out how your practice will benefit!

Resources

http://www.icd10data.com/ICD10PCS/Codes/0

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