AAOS Bulletin - December, 2005

Do-it-yourself coding

Three orthopaedic surgeons make the case for doing it yourself

By Mary Ann Porucznik

With all the responsibilities that orthopaedic surgeons have—whether in private practice, academics, or a group practice—why should they assume the additional task of doing their own coding? Because doing it yourself can mean higher, faster reimbursements and improved compliance, according to three AAOS fellows who have been coding their own office visits and surgical procedures for years.

More E&M consultations

J. Lex Kenerly, MD, a general orthopaedist in a solo practice in Jesup, Ga., has been doing his own coding for six years. “In a small town like this, we’re a bit isolated and orthopaedic-specific resources are hard to come by,” he said. “So I checked the Internet for ways to improve my operations. I found a site called OrthoCoderMD.com—run by AAOS member John E. (Jack) Ritchie, MD—that taught me more coding than I ever knew was out there.”

The site includes orthopaedic-friendly tools and information, with examples that can be readily understood and applied.

“Before, I would just guess, particularly when coding evaluation and management (E&M) office visits,” said Dr. Kenerly. “But I discovered I was coding too low. Now, I have a clear method of understanding the level of service for each office encounter, whether it’s a new patient, a follow-up visit, or a consultation. And I end up billing for a lot more consultations.

“You’ll certainly benefit from doing your own coding,” continued Dr. Kenerly, “with increased reimbursements, improved compliance and a reduced risk of audit.”

Code before you bill

William Creevy, MD, who practices at Boston Medical Center, now has his entire department doing its own coding. “I didn’t realize how important coding was until I attended a coding course during an AAOS Annual Meeting,” he said. “Later, I signed up for one of the two-day courses offered by the AAOS and KarenZupko Associates, and really got charged up.”

Dr. Creevy credits do-it-yourself coding as one of the reasons revenues and reimbursements in the orthopaedic department have markedly improved. “It wasn’t the sole factor, but it certainly was important in increasing our revenues and reimbursement rates,” he said.

“What I recommend, particularly in surgery, is that the orthopaedic surgeon sit down and figure out the codes for the procedures before dictating the operative report,” said Dr. Creevy. “Once you’ve done that, you’ll know how to bill the payer and what to say in the operative report so it parallels the bill and supports your reimbursement. Doing your own coding ensures that the documentation and the claim match up.”

If not you, who?

“If I, as a trained orthopaedic surgeon, am not sure how to code a procedure, how can a clerk reading my operative report days later be able to determine what codes to use?” asked Paul Abbott, MD, of Vail Orthopaedics and Sports Medicine, in Vail, Colo. He and the other six physicians in the practice have always done their own coding.

“No one understands what happens in the operating room better than the orthopaedic surgeon,” said Dr. Abbott. “If the surgeon doesn’t do the coding, someone else is interpreting the operative notes. And if they misinterpret or don’t code properly, the surgeon could be charged with insurance fraud and face serious fines.”

Most of the subspecialists in Dr. Abbott’s office have their subspecialty codes memorized. A certified coder in the practice’s billing office provides an accuracy check, but coding is not a clerical issue, according to Dr. Abbott. “It’s a medical issue,” he insisted.

M. Bradford Henley, MD, chair of the AAOS Coding, Coverage and Reimbursement Committee, agrees.

“Your practice manager will tell you that back-office staff time is better spent appealing claims than coding operative reports,” said Dr. Henley. “Having physicians perform their own coding adds more value to a practice than having staff read, review and code dictated operative reports. By doing the coding yourself, you free up your staff’s time so they can appeal denials and low reimbursements, resulting in the addition of revenue to your practice.”

Excellent resources

If you’ve never done your own coding, these surgeons can recommend some helpful resources.

“The Academy has made an excellent choice in coding education, partnering with KarenZupko and Associates,” said Dr. Abbott. “They walk you through the process, using real examples that apply to an orthopaedic practice. An added benefit is that they will respond to e-mail questions even after the course is over.”

To give you a basic background in coding essentials, Dr. Creevy recommends attending a coding Instructional Course Lecture sponsored by the Academy before attending the Zupko course. He also relies on the Orthopaedic Code X program, which combines six coding databases (Common Procedure Terminology, ICD-9, Global Service Data, Resource Value Units, Correct Coding Initiative edits and the Healthcare Common Procedure Coding System) into one powerful program.

“In a large practice or medical center like ours,” said Dr. Creevy, “it may be worthwhile to have KarenZupko and Associates give a course on site.”

“You may even want to read the code book itself,” said Dr. Kenerly. “A good place to start is with the AAOS CPT/RVU Coding Guide for Orthopaedic Surgery.”

For a list of upcoming courses by KarenZupko and Associates. For more coding resources, visit the AAOS online Educational Resources Catalog.

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