Arthroscopy Billing and Coding for 2023

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Two of the most common surgeries for the hip and knee are arthroscopy and joint replacement. In arthroscopy procedures are performed into the joint through a scope. Arthroscopic procedures performed by orthopedic surgeons and podiatrists are some of the most common surgeries performed with insurance companies spending a lot of money on these procedures. Because of the frequency in which these procedures are performed, insurance guidelines and policies are ever-changing, making it difficult to keep up with what is currently payable, and what is not considered medical necessary or experimental and investigational.

The expectation of this conference is that the attendee upon the completion of the conference should have an understanding of assigning codes and modifiers for reimbursement of all arthroscopic procedures, in addition to the other insurance guidelines and rules that have to be followed. We will also discuss tips on what is the best practice for documentation to be able to pass an insurance audit. Attendees will walk away with the most current trends in arthroscopic surgery.

Learning Objectives:

• Assign the proper codes for arthroscopic procedures
• Know current CMS NCCI Policy Manual guidelines related to hip and knee procedures
• Learn the proper assignment of modifiers for added information to the claim
• Understand coding for joint replacement
• Quickly code surgery for complications in joint replacement
• Identify common codes used in arthroscopic surgery for prior-authorization
• Write effective appeals when inappropriate denials are received.

Areas Covered in the Session:

• Arthroscopic vs open procedures
• Applying  the new descriptions for limited and extensive debridement, 29822 and 29823
• Correct documentation to report the removal of loose or foreign bodies
• Coding for superior capsular reconstruction
• The differences between SLAP repair and Bankart’s, 29806 and 29807
• Current NCCI edits for shoulder arthroscopy
• Review the NCCI Policy Manual guidelines for additional policies applied by Medicare and commercial insurance
• Writing appeals when claims are denied inappropriately

Suggested Attendees:

• Billers
• Coders
• Administrators
• Managers
• Supervisors
• Physician
• Non-Physician providers
• Qualified Healthcare Professionals
• Surgery Schedulers
• Claims adjusters
• Case Managers
• Physician Assistants
• Revenue Cycle Staff
• Caseworkers
• Nurses
• Reimbursement Staff
• Practice Manager
• Insurance Claim Processors
• Reimbursement Specialist and Staff
• Non-Physician Practitioners

Presenter Biography:

Lynn M. Anderanin, CPC, CPB, CPMA, CPC-I, CPPM, COSC is the Sr. Coding Educator for Healthcare Information Services, a revenue cycle management and consulting service in the Chicagoland area. Prior to relocating to Chicago, Lynn was the Billing Office Manager and surgical coder for Hand Surgery Associates, now Michigan Surgery Specialists in the Detroit Area.  She has over 39 years of experience in all areas of the physician practice including Practice Administrator, Billing Manager, and Director of Operations.  Her experience is primarily in the specialties of Orthopaedics, Rheumatology, and Hematology/Oncology. She has been a speaker for many conferences, including the AAPC National Conferences and Workshops, Community Colleges, Audio Conferences, Certification classes, and Webinars.  Lynn became a CPC in 1993, a Certified Instructor in 2002, a Certified Orthopedic Surgery Coder in 2009, an examination in which she participated in creating. She passed the Certified Practice Manager exam in 2015, the Certified Medical Auditor exam in 2016, and the Certified Professional Biller exam in 2021. Lynn is the founder of the first local chapter of the AAPC in Chicago, which is now 25 years old, and a former member of the AAPC National Advisory Board as well as several other committees for the AAPC.

Snippet From Our Previous Session