Category: Coding & Documentation


CMS Updates Physician Assistant and Nurse Practitioner Billing

AAOSNow – May 2022 by Sarah Wiskerchen In January, CMS introduced guideline changes to its Medicare reporting rules that impact PA/NP billing. These changes could require practices to modify how they report split/shared services. Previously, shared services were frequently reported in the name of a physician. Now, new rules determine who can report the services....


Navigating the National Correct Coding Initiative

AAOSNow – July 2021 by Sarah Wiskerchen and Michelle Abraham For procedural coding in orthopaedic surgery, physicians, and their staff primarily rely on two information sources: Current Procedural Terminology (CPT) and the AAOS publication Complete Global Service Data for Orthopaedic Surgery (GSD). Practices may also be subject to payer-created coding and reimbursement guidelines, the most...


‘Technical Corrections’: CPT Evaluation and Management Publishes Additional Guideline Revisions

AAOSNow – June 2021 by Sarah Wiskerchen and Michelle Abraham Since the adoption of the CPT® Evaluation and Management (E/M) Office or Other Outpatient guidelines changes by the American Medical Association (AMA) on Jan. 1, numerous questions have been raised regarding the ordering of tests and medical decision-making (MDM) credit. On March 9, AMA published...


New Procedures Added to Medicare’s Prior Authorization (PA) List Effective 7/1/21

May 26, 2021 Since 7/1/20, when CMS initiated a requirement for specific procedures to be prior authorized, we have sent out two KZAlerts about the PA process Alert 1 Alert 2 CMS says the PA policies are to ensure Medicare patients receive “necessary care” and “reduce unnecessary increases in the volume” of covered outpatient services....


Is Time on Your Side in 2021?

AAOSNow – November 2020 by Margaret M. Maley In 2021, medical decision making (MDM) or time can be used to select the level of service for evaluation and management (E/M) codes for new or established outpatient visits. Although most physicians will choose the level of new or established patient visits based on MDM, it is important to...


Five Coding Tips for Dealing with Third-party Billing Entities

Five Coding Tips for Dealing with Third-party Billing Entities AAOSNow – February 2020  by Sarah Wiskerchen, MBA, CPC Whether due to the complexities of hiring billing staff or a result of hospital employment and practice acquisition, many orthopaedic practices are moving their billing operations to a third-party entity or centralized billing office (CBO). This process...


Prior Authorization Chaos is the New Normal for Spine Surgery

ORTHOWORLD – December 11, 2019 In 2017, the American Medical Association surveyed physicians across all specialties about the amount of time spent by them and their staff on patient prior authorizations. The response was striking. Eighty-six percent of offices reported that their prior authorization activities had increased significantly over the last five years, and the...


All Work (RVUs) and No Pay?: Eight Questions to Ask the Hospital about Its Work RVU Compensation Formula

GreenBranch.Com – Jan/Feb 2013 by Sarah Wiskerchen As more surgeons and specialists are offered hospital employment, work RVU-based compensation agreements are becoming more sophisticated and complex. In order to have meaningful conversation with health system administrators and ensure that a compensation agreement addresses all issues pertinent to the physician’s practice and specialty, physicians practice and...


Therapy Billing: Be Sure Your Team Is Doing Things Right

Therapy Billing: Be Sure Your Team Is Doing Things Right AAOSNow – October 2019  by Sarah Wiskerchen, MBA, CPC Many orthopaedic surgeons are adding physical and occupational therapy services to their practices. This can be daunting for in-house billing teams, as they may lack experience with the new services, therapy terminology, and associated Current Procedural...

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