Making sense of confusing anatomy terms in the op notes when you're billing in orthopedics is not fun. But your grasp on orthopedic anatomy is key to billing and coding properly. Learn how to streamline your claims to make your billing in orthopedics simpler and more accurate.

Take the Confusion Out of Hand Surgery Billing

When you're billing in orthopedics, hand surgery claims can be the most frustrating of all. You have to read and interpret the op note thoroughly, as well as understand the anatomy references in order to code the procedure and diagnosis properly.

You need to know the anatomy of the hand and wrist, including how all the tendons connect and interact. Most surgical procedure codes don't designate which digit the physician is repairing, but you still need to identify the specific digit. Append HCPCS Level II modifiers to the CPT codes to identify the digit(s).

Use modifiers FA and F5 to the left and right thumbs, respectively. Use modifiers F1, F2, F3 and F4 for the fingers on the left hand, and use F6, F7, F8 and F9 for fingers on the right hand.

How to Use Unlisted-Procedure Code When Billing in Orthopedics

When billing in orthopedics, you'll certainly encounter situations in which you have no choice but to use an unlisted-procedure code. For example, when the orthopedist performs a laminotomy and extension of herniated thoracic disc, you'll soon realize that the only thoracic codes are for transpedicular or costovertebral approaches.

You'll need to use an unlisted-procedure code in this case, which can make your billing in orthopedics a bit more labor-intensive. Whenever you have to use an unlisted procedure code, you must ensure that the orthopedist documents,the procedure carefully and that you include certain information in your claim.

Here are a few tips regarding using unlisted-procedure codes when billing in orthopedics:

- Include a cover letter when you file the claim that states why you are using the unlisted-procedure code, which explains in simple layman's terms what the orthopedist did;
- Include diagrams or photographs of the procedure to better help the reviewer understand the procedure;
- Make sure you give the reviewer a way to contact you with questions; and
- Reference a similar listed procedure code with an established reimbursement value to suggest an appropriate fee.




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