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Coders Beware: Orthopedic, Spine Coding Coming Under Scrutiny

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Healthcare providers are facing scrutiny for some orthopedic and spine procedures, including joint replacement, which has a 12.6 percent Medicare improper payment rate, according to an AIS Health report.

Medicare contractors are now conducting pre- and post-payment reviews of joint replacements and are looking for providers to prove all other more conservative treatments were exhausted before proceeding to surgery.

Spinal fusion has also been added to the Program for Evaluating Payment Patterns Electronic Report's list of risk areas. Studies have shown a 15-times increase in fusions from 2002 to 2007.

Experts suggest adding more details to documentation to prove necessity for a procedure, as well as making sure coders understand the technologies surgeons are using to make sure the codes accurately reflect such.  

More Articles on Coding, Billing and Collections:
5 Ways to Make Sure Your EHR is Ready for ICD-10
CMS to Use ICD-10 Codes to Spot Fraud Starting Oct. 1
Dealing With the Decline of Fee-for-Service Reimbursement: 4 Strategies

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