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Majority of Code Denials Can be Successfully Appealed

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At the 12th Annual Spine, Orthopedic and Pain Management-Driven Conference + Future of Spine in Chicago on June 14, Stephanie Ellis, RN, owner and president of Franklin, Tenn.-based Ellis Medical Consulting, discussed coding and current procedural terminology issues in orthopedic and spine ASC facilities.

There are a number of changes and detailed nuances when coding for billing of certain orthopedic and spine surgeries. Ms. Ellis went through 15 common codes, and while they can be challenging, she said reimbursement denials can often be appealed.

"Only 35 percent of providers fight denials," she said. "You can be successful about 80 or 90 percent of the time, unless you have a provider who is actually trying to do something that is a compliance problem. Unless there is conflict, you have a high chance of getting your money back if you fight these denials."

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