Commonly Asked Coding Questions

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

This month’s coding column addresses commonly asked questions related to orthopaedic coding and reimbursement issues under the American Medical Association’s (AMA) Common Procedural Terminology (CPT) rules. Interlaminar stabilization Q: Previously, we were instructed to report the work associated with the coflex® interlaminar technology as an unlisted code. We are having significant difficulties in getting paid and want to ensure we are billing the service correctly.

CMS Announces ICD-10 Testing Dates

The Centers for Medicare and Medicaid Services (CMS) has announced three testing dates leading up to the Oct. 1, 2015, implementation of the International Classification of Diseases–10th Edition (ICD-10). According to CMS, the first testing week will be Nov. 17–21, 2014. Two additional testing weeks are scheduled in 2015: March 2–6 and June 1–5.

Balanced Scorecard for the Medical Practice

Chris Dugger

What is a Balanced Scorecard (BSC)? Can your practice benefit from implementing the concept? At our 14-surgeon orthopaedic practice, implementing a BSC resulted in a more systematic focus on key performance metrics that impact the patient experience and monitor the effectiveness of a range of internal processes. The BSC is a reporting and strategy tool that has been used since the 1990s in a range of industries outside of healthcare.

Jack of Orthopaedic Surgery, Master of Business

Douglas W. Lundy, MD, MBA, FACS

I know a physician with four degrees who says that the physician with only two degrees is an impaired physician. Although this may not be an accurate assessment, it does raise the question: “How useful are advanced degrees outside of medicine to orthopaedic surgeons in their daily practices?” In my opinion, having an advanced degree in business is very valuable.

Solo Practice: Not Dead Yet

A roundtable discussion with orthopaedists who “go it alone” The future of the orthopaedic solo practitioner concerns Stuart J. Fischer, MD, a member of the AAOS Now editorial board who is himself in private practice in Summit, N.J. Recently, Dr. Fischer convened a virtual roundtable of the following private practitioners to discuss the issue: James W. Barber, MD, who is in private practice at Southeastern Orthopaedics in Douglas, Ga. Basil R.

Is It Professional Courtesy or Fraud?

William R. Pupkis, CMPE

In the past, it was common for physicians to give “courtesy discounts” to colleagues and others. But passage of the Health Insurance Portability and Accountability Act, HIPAA, in 1996 made these discounts potentially illegal, with significant civil monetary and criminal penalties. Not collecting deductible or coinsurance payments may have serious repercussions for a practice.

Benchmarking PT Programs

Cary B. Edgar

Benchmarking is a process that enables businesses, including medical practices, to measure their products and services against their peers. Benchmarks can help an orthopaedic practice determine whether its physical therapy (PT) program is operating at an optimal level, what functions need to be improved, and how to approach improvement efforts.

AAOS Enhances Group Purchasing Program

Howard Mevis

The value and cost savings gained by participating in the AAOS Group Purchasing Program (GPP) can be substantial (see “A Great Way to Reduce Practice Expenses,” AAOS Now, September 2014). That’s because the AAOS GPP, powered by MedAssets, provides unparalleled access to orthopaedic supplies and equipment at competitive prices. Participants pay no enrollment or upfront fees, and no purchase commitment is required.

Lease or Buy?

Looking to update or expand your practice? If so, you may also be weighing whether to lease or buy equipment. The decision is not always an easy one to make because the two acquisition options have both advantages and disadvantages. For example, leasing generally requires a minimal down payment (or none); it may protect the practice against obsolescence; and payment may be spread over a longer period of time. So, upfront costs are lower, which frees money to be invested elsewhere.

Using Peer Review in Risk Management

Walter G. Robinson, MD

Here at Panorama Orthopedics & Spine Center in Denver, potential medical liability cases are everyone’s concern. That is due to the process we have developed for handling “risk management cases.” Our 34-physician group supports a culture of mutual accountability and respect. About a year ago, as part of our risk management efforts, we implemented a process of “peer review” of cases that posed a potential liability risk.