Orthopedic Spine Surgery Case — Surgical Coding Series: WHP Coding Conundrums
As part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case StudynnPreoperative Diagnosis:n
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- Degenerative disk disease, L5-S1.
- Discognetic back pain.
- Foraminal stenosis, L5-S1.
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nPostoperative Diagnosis:n
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- Degenerative Disk disease, L5-S1.
- Discogenic back pain.
- Foraminal stenosis, L5-S1.
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nProcedure performed:n
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- Anterior lumbar discectomy, decompression of the spinal canal ad neutral foramen L5-S1.
- Anterior lumbar fusion. L5-S1.
- Application of a 12 mm intervertebral biochemical device with bone graft and BMP, L5-S1.
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nComplications: None.nnFindings: There is significant degenerative disk disease and associated collapse with L5-LS1. A thorough decompression was completed and performed with decompression of the neutral foramen and restoration of lumbar lordosis and disk space height. Final images demonstrated hardware in good position. The procedure was performed without complication through an anterior retroperitoneal approach by, this will be dictated separately.nn22612 – Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)n22614 – Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)n22558 – Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbarn63047 – Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbarn22840 – Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)n22853 – Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)n61783 – Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure)n76000 – Fluoroscopy (separate procedure), up to 1-hour physician or other qualified health care professional time, other than 71023 or 71034 (eg, cardiac fluoroscopy)n20930 – Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)nM48.07 – Spinal stenosis, lumbosacral regionnM51.37 – Other intervertebral disc degeneration, lumbosacral regionnM47.817 – Spondylosis without myelopathy or radiculopathy, lumbosacral regionn
The Colorado Department of Health Care Policy & Financing recognizes some providers have had difficulties submitting claims during the transition to the new claims payment system (the Colorado interChange).nnIn an effort to ensure providers are appropriately paid for services to members, they are temporarily changing the limit for timely filing.nnEffective May 12, 2017, the timely filing limit will be extended to 240 calendar days.nnTherefore, they recommend providers hold claims with a DOS after December 1, 2016 (that are outside the 120 days timely filing limit) and do not submit those claims until after May 12, 2017. The system will automatically calculate the additional time and providers do not need to take action to receive the extension during claims submission.nnEffective November 1, 2017, the limit will be changed back to 120 calendar days.nnOn November 1, 2017, all claims with a DOS prior to July 4, 2017 will be outside the timely filing limit of 120 days, and providers will need to submit additional documentation to request a timely filing extension.nnExamples:n
Week 1 – Industry Hot Buttons!nnModifier 25: Modifier 25 landed itself on both private payer and the OIG hit lists again this year for overuse and blatant misuse leading to millions in overpayments – and everyone wants their money back! Applying Modifier 25 incorrectly can cost your practice tens of thousands of dollars! Understanding this modifier’s appropriate application can be very tricky.nnHere are a few questions to consider before sticking that modifier on your next claim:n
Republicans and the Trump administration are reported to be close to amending the health care proposal on overhauling Obamacare.nnThe Trump administration’s push to revive the moribund GOP health care proposal has apparently paid some dividends. The White House and key Republicans in the House of Representatives are reportedly close to an agreement to amend the bill so that states could opt out of two popular Affordable Care Act provisions, including one that requires individual insurance plans to cover 10 “essential health benefits.”nnThe other provision, known as “community rating,” bars insurers from varying premiums based on health status or medical history. It also requires insurers, under “guaranteed issue” rules, to offer coverage to all who want it. A proposal from Rep. Tom MacArthur, R-N.J., who leads the moderate GOP Tuesday Group, would allow individual insurers to charge plan members different rates based on their health status.nnThe proposal was negotiated with Rep. Mark Meadows, R-N.C., who heads the conservative House Freedom Caucus. The caucus announced their support for the deal on Wednesday. That could allow a House vote by Friday on the bill. House passage of the GOP bill would give President Donald Trump a key legislative success ahead of his 100-day mark this weekend. However, House Speaker Paul Ryan, R-Wis., wouldn’t speculate on timing for a possible vote.nnRep. Mark Sanford, R-S.C., who often sides with the Freedom Caucus, said he will support the revised proposal after “acceptance of the fact that we’re not going to repeal the Affordable Care Act.”nn“It’s not a repeal, lets be clear,” Sanford told reporters on Wednesday. “I think it’s very important to be clear with the American public and not to oversell this thing: ‘Oh we repealed it’. No we didn’t repeal the Affordable Care Act. We have trimmed back a couple of its key features…I think that, in short form, it’s the most you can get out of this conference. “nnMacArthur’s proposal addresses the Affordable Care Act’s community rating system, in which the entire pool of plan enrollees pays the same premium rates. That spreads the higher costs of sicker plan members among all who buy coverage. Both guaranteed issue and community rating helped cut the number of uninsured people with pre-existing conditions by 3.6 million, or 22 percent, from 2010 to 2014, according to federal estimates.n
Welter Healthcare Partners is excited to present our helpful career advancing tips and strategies to sharpen the skills prospective employers look for in a coder!nnPRACTICE: I’m sure you’ve all heard the old adage: Practice makes perfect! As simple as it sounds, most of us don’t make or take the time to adequately practice, especially when approaching a new project, subject or task. It takes an incredible amount of hours to master a subject…10,000 hours to be exact! Acknowledge the level of difficulty associated with any new task. Plan and prepare for mistakes. Pick your battles. Ensure enough time is set aside to complete the task at an exemplary level. Leverage all tools and resources. And Keep Practicing!!!
One of the best life lessons I ever learned is always hire higher! Hire people better than yourself! Some managers are intimidated to do this, thinking they may be replaced, they may lose control, etc. If that could happen it will anyway! Always recruit and hire people better and when possible more knowledgeable than yourself! If they are not more knowledgeable can they learn? Can they grow? Can they take your organization to beyond where it is today?nnIn a service business (and healthcare is the biggest one by far) proper staffing is not just one thing that needs to be done well it can be the only thing that needs to be done well, because when done right the rest will be taken care of.nnWe do staff recruitment and placement and we do it well!nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners