Code and Modifiers Used by Orthopedic Surgeons in Medical Specialities Pertaining to Injuries and Diseases

For established patients receiving evaluation and management, providers may bill for these services using the CPT codes 99212, 99214. Choosing the correct code depends on the patient’s history, examination findings, and decision-making complexity. If complexity is found to be straightforward taking the provider less than 10 minutes, the billing code will be 99212 (Engle, 2014). If the history and examination findings result in moderate decision-making complexity, requiring more time from the practitioner and more diagnostic procedures the billing code will be 99214 (Engle, 2014). While, Ms. Trinidad does not encounter established patients in the emergency department, within my clinical hours, Ms. Rossow encountered several established patients of various levels of complexity. The billing code 99212 is appropriate to use for patients with low complexity, such as one of Ms. Rossow’s patients whose visit was due to elbow pain after a fall a week ago. Mrs. Rossow also managed the care of patients with a higher level of complexity such as a middle-aged male with a history of recent prostate cancer and a chief complaint of abdominal pain and fever.

After sustaining a knee injury that required for surgical intervention while in high school, I struggled with recurring ailments throughout my intercollegiate career. It was not until my father, who is an Osteopathic physician, was performing manipulation on me did we begin to diagnose the potential causes. The issue was muscle imbalance and limited flexibility in certain areas of my body that was shifting majority of my weight onto my knees while performing certain movements. This went unnoticed by physicians because while performing examinations the scope was concentrated on the immediate areas around my knee. With the knowledge I obtained through manipulation I have been able to treat my knee ailments by strengthening and lengthening muscles throughout my body. Having this experience helped solidify that if I am to be the physician I aspire to be, it is imperative to be trained in this form of medicine.

OrthoOklahoma is an orthopedic medical clinic with a physical therapy branch that provides outpatient physical therapy care. The facility has a staff of three licensed physical therapists and a physical therapy assistant along with four physical therapy techs. I was able to observe all three physical therapists, Megan Ripley, Joe Ogle and Ken Roberts. At OrthoOklahoma, the most common patients are post-surgery from repairs of muscles, bones or joints. While shadowing these therapists, I observed cases of total knee replacement, total hip replacement, ACL/meniscus repair, rotator cuff repair, frozen shoulder, labrum repair, and other ailments from wear-and-tear and aging. This experience allowed me to talk to physical therapists about the ins and outs of their job, learn about different exercises and routines for treatment of injuries, and really get an idea of the work it takes to become a well-respected physical therapist.

Additionally, being a chiropractor is another career that sparks my interest. "Chiropractors care for patients with health problems of the neuromusculoskeletal system, which includes nerves, bones, muscles, ligaments, and tendons" (U.S Dept. of Labor, "Chiropractors"). Chiropractors examine patient's physical state, run tests, and perform "neuromusculoskeletal therapy" (U.S Dept. of Labor, "Chiropractors"). These responsibilities are very important considering the fact that they are working on patients' nerves and other important body parts. This career involves you to be more hands-on with the patient's injury and so while in the process of treating the chiropractor should make a habit of checking with the patient concerning their comfort

To determine the CPT code for the above case scenario, the first step is to identify its category 1 which in this case will be emergency department services which range from code 99281-99288. In this category, the case scenario would also be assigned code 78000-79999 for nuclear medicine and code 76500-76999 for diagnostic radiology. The codes would be selected based on the chest x-ray and nuclear stress test done to the patient. Codes 99605-99607 would also be assigned based on the medication given to the patient. In category II of CPT, the case scenario would be assigned code 0500F – 0575F for patient management based on patient evaluation and prescription changing.

CPT code 99307: Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least two of these three key components: a problem focused interval history, a problem focused examination, straightforward medical decision making. Usually the patient is stable, recovering, or improving.

Current Procedural Terminology (CPT) is published by the AMA and updated yearly. This terminology was devised to have a standard language of defining medical and surgical procedures for billing purposes. Insurances use this information to evaluate and decide on the proper amount of reimbursement (Wager et al., 2009).

The Current Procedural Terminology (CPT) codes, are codes a medical biller uses to report healthcare procedures and services. Both medical billers and providers use CPT codes as a way to communicate with insurance companies. Proper coding and documentaition is essential for reimbursement. Proper coding and documentation also makes the difference between full reimbursement and reduced reimbursement or even a denial. Each code that is sent to a payer on a claim, has to have supporting documentation. For example, if a patient is seen for a urianary tract infection and during the visit the patient receives a urianalysis, you would expect to see an order, the correct CPT code, and the results for a urinalysis in the patients chart. I have always

CPT coding is to make sure the patient is getting billed for the correct services that was rendered. The Tabular list is a compilation of codes divided in different categories: Category I, II, III. Category I is the basis of CPT codes. Category II is used for tracing information. Category III is short term codes for collection of services rendered and procedures. There are 15 appendices that are used as guides. Modifiers help report situations. Locating codes are done by finding the main term. Assess information provided such as notes and terms. Locate the code. Guidelines are presented in the front of the sections. Special instructions help point out rules on how to use codes. Instructional notes are located in parentheses

The CPT code set is used to describe medical, surgical, and diagnostic services and is designed to communicate information about procedures with coders, accreditation organizations, and physicians, patients. The purpose of the codes is for financial, and administrative and analytical purposes. For example, if a physician performs a total abdominal colectomy Cpt code (44159) should be used. However, Cpt code (49000) exploratory laparotomy should not be used because it is included with code (44159) it is incorrect to bill for both. Medicare and Medicaid identify CPT codes as level 1 of the Healthcare Common Procedure Coding Systems. When using Category II codes the 5th character is identified by an alphabetical character. The CPT section includes information about modifiers, measures and the source, there is currently 11 CPT Category II codes. CPT Category III codes are used for data collection services and procedures. These codes are intended to be used in the approval process by the Food and Drug Administration

Mobility grants opportunity and lifelong experiences through the gift of exploration and independence. Without autonomy of movement in one’s life, there are struggles accompanied by frustration do to the lack of freedom and ability. It is an orthopedic surgeon’s job to bring function to one’s life even if they have never been granted movement without restraint before. Orthopedic surgeons receive patients whose freedom of movement have been compromised and then return it back to them. Orthopedic surgeons give immeasurable opportunities and life experiences back to their patients because of their perseverance and commitment to their patients and careers.

Healthcare providers use Current Procedural Terminology (CPT) codes for communicating what services was rendered to the patient, to insurance companies for billing purposes. CPT category 1 codes are codes that relate to the services and procedures rendered to patient's primarily in an outpatient facility. Category 1 codes are updated yearly and are for procedures that are consistent with medical practices and procedures widely performed. Category 1 CPT codes are sectioned into six categories which include evaluation and management (EM), anesthesiology, surgery, radiation, pathology/laboratory, and medicine. CPT category 2 codes are codes that are used to communicate services rendered performance measurements and is also updated yearly.

This patient under went a RIGHT UNICONDYLAR ARTHROPLASTY. This procdures code is listed as one for our CJR program for total knee procedures with CMS however partial knee replacements are excluded. So is there another procedure code that should have been used for this patient ? I need to know because if that is the case as we gather these patients by their required codes I will need to manual remove all of the unicondryle

After review of the clinical information provided by Dr. Yakov Beim the Medical Director has determined that Arthrocentesis which is the use of a syringe to collect synovial fluid from a joint capsule or inject medication in to a joint for the purpose of diagnosing/treating gout, arthritis, and synovial infections such as septic arthritis (procedure where fluid is drained from or injected into a joint) is not medically necessary. The information submitted by the provider is limited for the requested service. We have repeatedly requested information and it has not been submitted. We have reviewed any past medical history and any current information we have on you and we have no other source of information to support the medical necessity for

Generally, the orthopedic surgeons treat bone tumors, arthritis, cerebral palsy, dislocations, osteoporosis, fractures, sprains and strains and spine disorders like scoliosis, sciatica, ruptured disc, etc.