Orthopedic Billing Changes in 2018

The New Year has come and gone, and we know what that means: change. Orthopedic billing changes were put into effect January 1st with new, bundled, and removed codes, along with much bigger changes. During this time, it is important that you ensure your billers are aware of these changes implementing them alongside your practice. By doing so, your business is more likely to realize efficiency and profitability gains from these changes.


Recent Billing Changes

The last few years has presented us with a number of orthopedic billing changes including the official switch to ICD-10 being among them. There were also 264 new codes, 134 revised codes, and 143 deleted codes within the orthopedic coding structure. On top of all this were also a number of changes in orthopedic billing guidelines. The majority of these billing changes effected kyphoplasty, vertebroplasty, image guidance, biopsy, joint injections, and ultrasound guidance. There was also a change in the CPT code modifier 59, of which modifiers XE, XS, XP, and XU were introduced. Now that we’re all caught up, it’s time to prepare for 2018.


Orthopedic Billing Changes Coming in 2018

As the routine goes, this upcoming year the Orthopedic billing changes will include more new, bundled, and removed codes. Most of these new codes will be applied to x-rays, E/M prolonged service codes, and paravertebral facet blocks. Most of the changes in CPT 2018 to the Musculoskeletal System codes (20005-29999) and Nervous System codes from 2017 impact the reporting of orthopaedic spinal procedures.  Only one new code has been added and two have been deleted.  A number of instructional notes have been added to clarify proper reporting of certain codes. Perhaps the biggest change we could see in 2018, is reforming the way hip and knee surgeries are paid for. This concept promotes paying healthcare providers for the outcome of the procedure performed, rather than paying for a specific procedure in general. Take a look at CMS’s billing guidance for major joint replacement (hip or knee) here. Be sure your orthopedic practice stays up to date and in the loop. Other coding changes include:


  • CPT 27197 – Closed treatment of posterior pelvic ring fracture/dislocation of the ilium, the sacral joint, and/or sacrum. Unilateral or bilateral; without manipulation
  • CPT 27197 is the procedure without manipulation.  This is one of those confusing codes that really is almost an evaluation and management service where you carry a 90-day global period and within that 90 days are managing the routine healing of that closed fracture even though it’s only been braced.
  • CPT 27198 – Closed treatment of posterior pelvic ring fracture/dislocation of the ilium, the sacral joint, and/or sacrum. Unilateral or bilateral; with manipulation
  • CPT 99151 – Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring a trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status, initial 15 minutes, patient younger than 5 years of age


Be Prepared for Anything

The implementation of ICD-10 brought around with it 264 new codes, 143 deleted, and 134 revised codes that apply to coding for an orthopedic practice. New rules related to modifier 59 and the introduction of the applicable modifiers XU, XE, XP, and XS are here to revolutionize orthopedics billing from here. Our team of skilled medical billing professionals display their understanding of the ICD-10, and proficiency at numerous ways in which the new requirements and coding changes impact orthopedics.


Change isn’t always easy, and we want you to know EchoScribe is here and ready to help. Consider our 20+ trained experts to outsource the management of your orthopedic billing. We can take the stress of new information, codes, or regulations, trainings, and education and put it aside as we manage and stabilize your organization’s RCM. Putting your RCM in the hands of EchoScribe will help improve cash flow, maximize reimbursements, increase efficiency and profitability, and keep your practice compliant.


About EchoScribe

We are a high touch, personalized medical billing and coding service that will cater our offering to your needs. Our low-cost offering has motivated over 60 healthcare institutions to make the switch from their in-house provider to our medical billing service. Our value proposition resonates well with physician practices keenly focused on their bottom line. While we may be small compared to some of our competitors, our impact on clients is huge. Let us handle all of your orthopedic billing needs.

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