Commonly Asked Coding Questions

Mary LeGrand, RN, MA, CCS-P, CPC

This month’s coding column addresses coding questions that have been submitted by AAOS members. Using modifier 58 in staged procedures Q: Our surgeon recently operated on a patient who had a traumatic injury to the lower extremity. The patient underwent initial excisional débridement at the first encounter on May 1, 2012. On May 3, 2012, the patient was returned to the operating room (OR) for a subsequent excisional débridement.

CPT Resolves Coding Dilemma

The American Medical Association has recently updated its CPT® 2012 guidelines to correct a problem in the guidelines applicable to the instrumentation, intervertebral device, and bone graft codes. As add-on codes, the instrumentation, intervertebral device, and bone graft codes must have an applicable “parent” or primary procedure code. CPT® 2012 did not originally list 22633 or 22634 as an applicable parent or primary procedure code for the add-on codes.

Peer Support When We Need It Most

S. Jay Jayasankar, MD; Sara Nadelman, MPH; Jo Shapiro, MD

Physicians hurt when patients hurt S. Jay Jayasankar, MD; Sara Nadelman, MPH; and Jo Shapiro, MD “It feels like the ground has fallen from underneath your feet and your breath has been stolen—you’ve made a medical error. Is there any way to undo it?” That was the reaction of David Ring, MD, to an adverse event he experienced. As physicians, we likely will or have already experienced similar emotions at some point in our careers.

New Tool Kit Helps Build Clinician Support Programs

Linda K. Kenney, with Winifred N. Tobin

When things go wrong in health care, patients and their families aren’t the only ones who suffer. In 1999, after I (Linda Kenny) experienced a near-fatal adverse event, the caregivers involved in my case—anesthesiologist, code team, and orthopaedic surgeon—openly shared with me the pain and devastation they were experiencing. At that time, support systems for patients, families, and clinicians were practically nonexistent.

What You Need to Know About Employment Agreements

Todd A. Rodriguez, JD

Consider these important issues before signing Todd A. Rodriguez, JD Whether you are joining a group practice or entering an employment relationship with a hospital, you should consider several significant legal and financial issues when negotiating your employment agreement. Before signing any agreement, you should review—with legal counsel as appropriate—and fully understand all the terms of the agreement. The following are among the most critical provisions to consider.

Building a Business Strategy

Frederick N. Meyer, MD

For several years, the AAOS has offered a variety of symposia on practice management, including two during the Annual Meeting—one directed to orthopaedic residents and the other to practicing orthopaedic surgeons. I’ve been to most of them, and in my opinion, the best one is the AAOS Practice Forward: Managing Your Practice in an Era of Health Care Transformation, which I attended last year.

EHR Implementation: Meaningful Use Stage 2

Howard Mevis

The Health Information Technology for Economic and Clinical Health (HITECH) Act passed in 2009 provided funds to reimburse physicians for the purchase and meaningful use of an electronic health record (EHR) system. Once the regulations were put in place, physicians and hospitals around the country began to purchase certified systems and make the transition from paper to electronic patient files.

EMR Compliance Depends on Good Practices

Peter Pollack

Authorship and accuracy are two keys to being compliant with electronic medical record (EMR) requirements according to Ranjan Sachdev, MD, MBA, CHC, an orthopaedic surgeon in private practice in Bethlehem, Pa., who is certified in Health Care Compliance. Speaking at the Practice Management Symposium for Practicing Orthopaedic Surgeons during the 2012 AAOS Annual Meeting, Dr. Sachdev outlined areas of compliance risk when using EMRs.

How Safe Is Your Office?

G. Klaud Miller, MD

When you consider “office safety,” what comes to mind? Do you think only of clean walkways and locked drug cabinets? Do you believe that simply meeting the defined safety requirements under the Health Insurance Portability and Accountability Act (HIPAA) or the Occupational Safety and Health Act (OSHA) is sufficient? If so, perhaps you need to broaden your thinking a bit.

Preparing Residents for the Challenges of Orthopaedic Practice

Frederick N. Meyer, MD; Marty Krawczyk

For years, orthopaedic training programs have done an excellent job of educating residents on how to diagnose and treat musculoskeletal problems. Graduates of orthopaedic training programs are skilled in surgical procedures of the musculoskeletal system. First-time pass rates on part 1 of the ABOS Certification examination are among the highest of any specialty. But in this increasingly complex world of medical practice, are we truly preparing our residents for practice?

Recruiting Physical and Occupational Therapists

Cary B. Edgar; Sue Bowles

Orthopaedic groups face many challenges in providing in-office physical and occupational therapy (PT/OT) to their patients—but attracting highly skilled, motivated therapists shouldn’t be one of them. Therapists employed by orthopaedic groups have an extremely high retention rate, and the vast majority report high levels of professional and personal satisfaction. The following recruiting DOs and DON’Ts should help you attract, hire, and retain excellent therapists.

ICD-10 is Coming—Are You Ready?

Jackie Ryan; Jerry Winkelmann

The transition to 5010 may be settling down for your practice, but don’t get too comfortable! The next major transition—to the new International Classification of Diseases (ICD)-10 coding system—is coming, and it is going to be bigger than 5010. Despite the fact that the U.S. Department of Health and Human Services recently proposed delaying ICD-10 compliance to Oct. 1, 2014, orthopaedic practices should continue to move forward with their ICD-10 preparations.