Hand surgery is a specialized field in the healthcare industry. It requires meticulous attention to detail, both in the operating room and in the billing process. Accurate coding plays a crucial role in ensuring proper reimbursement for hand surgery procedures. However, coding errors can lead to claim denials and delayed payments. Moreover, erroneous hand surgery billing can cause potential compliance issues.
In this article, we will highlight five coding mistakes that must be avoided in hand surgery billing. And how they can help in optimizing revenue and streamline the billing process.
Hand Surgery Coding Basics Simplified
The American Medical Association (AMA) maintains the CPT codes specifically for hand surgery. The CPT codes for hand and finger surgical procedures range from 26010 to 26989. Accurate hand surgery coding is crucial for two reasons:
- First, for the determination of the procedure performed
- Second, for assessment of the surgeon’s work
Despite the significance of precise hand surgery billing and coding, billers and surgeons often lack knowledge about the correct billing codes. Similarly, surgeon compensation structures can also influence coding patterns. Hand surgery coding mistakes, whether unintentional or fraudulent, can result in substantial fines and civil penalties.
In this article, we will explore common errors in hand surgery billing services. Also, we will be guiding how to avoid them. It will help your orthopedic practice to get accurate reimbursement and maintain compliance during payer audits.
Common Mistakes in Hand Surgery Billing
There are common mistakes that occur in medical billing services for hand surgery.
- Up-coding and Unbundling
- Addressing Location Specificity
- Higher Value wRVU
- CPT Codes 64718 and 24305
- Coding for Debridement as a Separate Procedure
Let’s discuss all of them in detail!
Up-coding and Unbundling
It is one of the most prevalent and damaging coding errors in hand surgery.
| Up-coding | Unbundling |
| It involves submitting a CPT code with a higher reimbursement value than the actual procedure performed. This practice is considered unethical and goes against the guidelines set by CMS. | It refers to coding at a lower level than the services provided. It is often out of fear of payer audits. Unbundling occurs when procedures that should be coded together are separated and assigned individual codes. |
While surgeons may not always handle the coding process themselves, they remain responsible for any violations. Therefore, surgeons should review the coding for their patients. This simple step is an indication to ensure compliance checks to prevent any violations.
Addressing Location Specificity
Accurate identification of location plays a pivotal role in hand surgery coding. Consistency is key when creating the operative note procedure list and documenting the operative details.
- For example, consider that you are reporting flexor and extensor tendon repair codes. CPT includes particular references to areas in the forearm, wrist, hand, and fingers. But still, coders mistakenly assign the wrong codes in hand surgery billing services. The problem lies in their selection of codes, as they choose codes based on the tendon insertion site. However, this doesn’t necessarily identify the precise and actual location of the repair.
- Similarly, zone 2 flexor tendon repairs in the hand require particular attention. Again, we have a separate CPT code that is used specifically for these procedures.
- Location specificity is also crucial in reporting fracture management. For instance, in the case of distal radius fractures, documentation should specify whether the fracture is extra-articular or intra-articular. If the fracture is intra-articular, the operative note must indicate the number of fragments.
Higher Value wRVU
Unlike salaried surgeons, some surgeons are compensated based on collections, or the wRVU model. Here, wRVU stands for ‘work relative value unit’. These surgeons have a greater financial incentive to utilize additional codes. Also, the same happens if they select procedures with higher-value RVUs.
A recent survey revealed that 23% of surgeons increased the number of procedures and tests offered. We can say that they spent more time with patients to maximize their profits. This productivity-based compensation model (wRVU) often encourages a higher rate of procedures.
CPT Codes 64718 and 24305
We use CPT code 64718 to identify the transposition and/or neuroplasty of the ulnar nerve at the elbow. This code is commonly used for reporting simple decompression procedures of the ulnar nerve. For example, anterior transposition or subcutaneous transposition. Anyhow, surgeons may opt to perform a submuscular transposition, which is also reportable under code 64718.
If the surgeon also performs tendon lengthening as a part of the submuscular transposition, an additional CPT code may be applicable, i.e., 24305. This code describes tendon lengthening in the upper arm or elbow for each tendon. Notably, there is no National Correct Coding Initiative (NCCI) edit between codes 24305 and 64718, thus eliminating the need for modifier 59 when using this combination of codes.
Coding for Debridement as a Separate Procedure
Debridement is considered a separate procedure only under specific circumstances. These include cases when
- A significant amount of contamination requires extended cleansing.
- The removal of substantial amounts of devitalized or contaminated tissue
- Debridement is performed as an independent procedure without immediate primary closure.
We use the 11042–11047 series of CPT codes for separate reporting of debridement. However, separate reporting is generally not permitted in conjunction with an open wound accompanied by a tendon laceration. We can only use these codes if the aforementioned criteria are met. Also, we have well-documented it in the operative report.
Likewise, CPT does allow for the separate reporting of excisional debridement. Here, coders can use the 11010–11012 series of CPT codes. However, this is applicable when debridement is performed in conjunction with open fractures or dislocations. In such cases, appropriate documentation of medical necessity is required. It will support the separate reporting of the debridement procedure.
Conclusion
As previously discussed, the importance of accurate orthopedic coding cannot be overstated. It can help avoid negative impacts on your orthopedic practice. To ensure precise orthopedic coding, it is highly recommended to seek assistance from expert orthopedic coders.
QPP MIPS is a trusted and reputable billing company. It specializes in providing comprehensive hand surgery billing services. By partnering with QPP MIPS, you can benefit from their expertise and knowledge. It will assist you in avoiding common hand surgery coding mistakes as well. Their team of professionals is well-versed in orthopedic coding guidelines, ensuring accurate reimbursement and compliance for your practice.
