Orthopedic therapies address musculoskeletal-related problems such as injuries, congenital deformities or anomalies, and illnesses No matter what kind of orthopedics your clinic specializes in; it needs a medical billing specialist who is skilled and experienced in specialized coding for billing to go smoothly. The ophthalmologist assigns a Current Procedural Terminology (CPT) code to each service they perform. The codes are revised yearly and can be found in the National Correct Coding Initiative (NCCI) guide from the Centres for Medicare & Medicaid Services (CMS).
Most frequently used CPT codes for orthopedic billing
- 99201–99499 Evaluation and Management
- Anaesthesia (00100–01999; 99100–99140)
- Surgical patients: 10021-69990
- Radiology: 7010–79999
- 80047 – 89398 for pathology and laboratory
- Medical: 90281-99299; 995001-99607
Surgery on the hands
- CPT – 11760 – Fixing Nail Beds
- Corpectomy; removal of all proximal-row bones (CPT 25215)
- Neuroplasty, which is coded as CPT 64721 (carpal tunnel release)
Release for Carpal Tunnel – 64721
- “Median Nerve Transposition and/or Neuroplasty.”
- The 29848 Endoscopic Carpal Tunnel Release
When to Use Orthopaedic Billing Modifiers?
Modifiers are two-character codes that change the definition of CPT codes and add more detail to the procedure for submitting claims. They utilize great accuracy while recording information in claims so that reimbursements can be processed quickly. Yet, if they have been misused, it can lead to severe penalties such as inquiries, fines, and even the cancellation of claims.
Level 1 –
Level I modifiers are numerical codes governed by AMA procedures, called CPT modifiers. They provide more information on the services and treatments available to the patient and reinforce other present information.
Level 2 –
HCPCS Modifiers are two-digit characters that consist of an alphabetic and numeric combination. These range from AA to VP and are revised annually by the Centers for Medicare and Medicaid Services (CMS).
| Modifier | Method | ASC/P Unit |
| -50 | bilateral methods | equally both |
| -51 | multi-step process | (P) |
| -52 | fewer services | — |
| -58 | After-surgery care is provided in stages or by the same doctor during the recovery process | equally both |
| -59 | separate methodological service | equally both |
| -73 | Before administering an anesthetic, the outpatient hospital or ASC operation must be halted. | (A) |
| -74 | Before administering an
anesthetic, the outpatient hospital or ASC operation must be halted. |
(A) |
| -76 | repetition of surgery or service by the same doctor | equally both |
| -77 | repetition of surgery or service by the same doctor | equally both |
| -78 | Postoperatively, return to the operating room for a related
process |
equally both |
| -79 | The same doctor may perform an unrelated treatment or provide a
service throughout the healing process |
equally both |
| LT & RT | Left side and right side | equally both |
| -TC | technical element | equally both |
Conclusion
CPT codes not only aid with billing and reimbursement but also monitor and analyze trends in orthopedic surgery. Clinicians can learn much about the efficacy of different approaches to treating orthopedic disorders by looking at the most frequently performed surgeries. This data can enhance patient outcomes, boost medical research, and direct the formulation of healthcare policy.