Whether medical or surgical, orthopedic treatments deal with problems arising in the patient’s musculoskeletal system. Orthopedic doctors solve all problems related to the movement and stability of the body, whether congenital or acquired, as a result of any injury or illness.
To engage with the patients and solve these problems, orthopedic doctors and clinics also need a billing system that oversees all collections. The orthopedic assigns a different Current Procedural Terminology (CPT) code to each service they perform on the patient, and knowing the code, the orthopedic medical billing expert makes the final bill for the patient.
Thus, these CPT codes and modifiers play a very important role in maintaining the clinic’s flow and allowing the billing process to go smoothly.
What are CPT codes?
A Current Procedural Terminology (CPT) code offers a streamlined and effective system of coding different medical services and procedures to allow easy and effective reporting, analysis, and categorization. These codes can help healthcare professionals and facilities streamline their medical billing process, including orthopedic medical billing, so they can easily navigate complex processes like claims processing and guideline development for any medical care reviews.
Types of CPT codes
CPT codes are of various types, but the three main types include:
1. Category I Codes
The descriptors in these codes refer to any procedure or service done by the doctor or the medical facility in general. These codes range from 00100 to 99499 and are divided into various subtypes depending on the type of service provided.
2. Category II Codes
These are tracking codes used supplementally for performance measurement. These are not always used, as they are not mandatory for the correct coding of the service.
3. Category III Codes
These are temporary codes used for recording any new technologies or procedures. They are used in data collection of the new service or procedure, which is not yet ready to be categorized within the category I code.
Commonly used Orthopedic Medical Billing Codes
- 99201–99499 – Evaluation and Management
- 00100–01999; 99100–99140 – Anaesthesia
- 10021-69990 – Surgical patients
- 7010–79999 – Radiology
- 80047 – 89398 for laboratory and pathology
- 90281-99299; 995001-99607 – Medical
Hands-on Surgery Codes
- CPT – 11760 for Fixing any defects in Nail Beds
- CPT 25215 – Corpectomy; removal of all proximal-row bones
- CPT 64721 – Neuroplasty, which is also coded as carpal tunnel release
Carpal Tunnel Release Code – 64721
- This code (64721) is used for Median Nerve Transposition or Neuroplasty.”
- 29848 – Carpal tunnel release using endoscopy
What are Modifiers in Orthopedic Medical Billing?
Sometimes, more detail is needed in the CPT code to encompass complex procedures/services when submitting claims. This is where modifiers come into play. These are short, two-letter codes that add a little more to the definition of the original code. These are very accurate to the type of data they represent, so any mistakes in recording the correct ones can lead to dismissal of the claim.
Modifiers in billing procedures like orthopedic medical billing are also of two major types:
1. Level 1
These modifiers are called CPT modifiers and are numerical codes governed by AMA standards and procedures. As we already said, these modifiers add to the original information provided by the CPT code and explain services and procedures in more detail than the original CPT code.
2. Level 2
These modifiers are based on the standards set by the Healthcare Common Procedure Coding System (HCPCS). These modifiers also consist of two digits but are different from the level 1 modifiers in that they consist of an alphabet and a numerical. These range from AA to VP. The annual review of these modifiers is done by the Centers for Medicare and Medicaid Services (CMS).
Some commonly used modifiers in orthopedic medical billing services include:
| 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 and RT | Left side and right side | equally both |
| TC | technical element | equally both |
Importance of CPT Codes and Modifiers
CPT codes and modifiers play a very important role in streamlining the billing services of hospitals and healthcare facilities. They are also important in orthopedic medical billing and allow doctors and hospital staff alike to store and manage important data.
By looking at the most commonly used codes throughout the hospital, the doctors can see the trends of the services offered in the hospital. This allows them to predict the services needed in the future and train themselves accordingly. This process also improves patient experience, opens doors for new research opportunities, brings innovations in treatment technology, and allows the hospital to make more profits.
Conclusion
CPT codes and modifiers are codes and numbers needed for an accurate and speedy medical billing process. Big healthcare corporations like AMA, HCPCS, and CMS set these codes. The codes designate the service or a procedure the doctor performs to treat the patient and thus help make the billing process easier for the orthopedic medical billing department. The codes are important in making claims and reimbursements easy and accessible for the people and can also be used to predict trends in the services offered to the patients. Thus, CPT codes and modifiers are an integral part of the healthcare provision and medical billing process. The billing authorities must, and doctors must take specific care to make sure they are using these codes correctly.