Spine and Pain Management: Ways to Improve Coding and Billing

Approximately four decades ago, surgical procedures were done inside the hospitals. Patients back then had to wait for weeks or even months just to settle an appointment. And typically, it would take several days to be admitted and a couple of weeks of recovery outside the premises. But as the nation strived for an improved health care system, Ambulatory Surgery Centers (ASCs) had been developed.

Since ASCs are health care facilities that offer the convenience of surgeries and medical procedures outside the hospital setting, it is critical to ensure accurate coding and billing in spine and pain management.

According to Lisa Rock, president of National Medical Billing Services, during Becker’s 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference on June 21, inaccurate and incomplete coding of complex procedures, such as spine and pain management, means ASCs will abandon reimbursement on the table often.

Moreover, medical billing companies in Houston have been providing quality medical billing services with the goal of providing the clients with the highest returns without sacrificing the level of service or patient support.

Nevertheless, such coding errors can lead to aggravating events and decreasing revenue for both patients and the centers. There are some ways to improve spine and pain management documentation and billing.

Identify the payer

Determine the payer of the claim. "We are in an ever-changing environment with more employer groups going self-funded, so it is important ASCs understand who, in fact, is paying the claim," said Ms. Rock.

It is critical for the pre-authorization staff to distinguish the one paying for the medical claims. It is needed for them to submit authorization requests to the particular individuals on time. In certain occasions, commercial payers demand more elaborate information.

Prepare for denials work

Denied claims come for a handful of reasons. This thing is usually because of a simple billing mistake suchlike demographic errors, incomplete application submission and invalid modifiers or diagnosis codes.

According to Ms. Rock, by clearly understanding the addressed issue in ASC revenue cycles, the officiated personnel can conclude relevant insights, narrow the target and implement new documentation strategies.

Ensure your coders are well-acquainted in spine anatomy and CPT codes

"If your coders don't understand the anatomy, you can miss out on revenue," Tamara Wagner, National Medical Billing Services' vice president of performance review.

Medical coders should be well-knowledgeable on the full anatomy of the spine, which aids them to interpret the right operative note for a surgical approach, level assignment, and diagnosis assignment.

Coders should also be able to match the spinal nerves involved to the most accurate CPT codes for the ASCs and the physicians to receive full and absolute reimbursement for the services yielded.

Get the physician’s detailed, accurate operative notes

According to Ms. Wegner, there is a probability of 50-60 percent of difficulty to the coder if the doctor’s documentation is either inaccurate or incomplete. To ensure that the medical coders assign the correct codes, medical doctors must provide detailed and accurate operative notes.

Usually, there are lapses within the report such us disparities between the procedure heading and the actual description. Practitioners may mislay some information that can significantly affect revenue. An accurate documentation is necessary for the intent of the procedure and how specialists do it.

For example, in spine surgeries, decompression documentation should specify each nerve targeted at each level for full reimbursement.

Ms. Rock shared the time when she had to follow up with a surgeon who had not noted the size of a lesion removed from a patient in the operative note. "He said it was the size of an olive, so I wrote back: Pimento-stuffed? Medium? Black?" she said. "I joke because I know how busy surgeons are, but if you're trying to get your bills, you need to have accurate documentation."

Be up-to-date of all medical policy changes among LCD carriers

It is essential to be well-aware of all the medical policy changes by carriers and commercial payers. These rules change more often and requiring substantial information regarding a patient’s total care process to reinforce medical necessity before authorizing procedure approbation.

"Discrepancies in these policies can be a challenge for coders to operate. Thus, coders must stay updated with the differences and modifications to each system’s requirements", said Ms. Wagner. Ms. Rock added that coders should also keep track of which codes have already been omitted or replaced for payers and disregard the claim if the code used is already old.

Hold patients accountable for their portion of the bill

By 2020, 40 percent of a healthcare provider's bill will be accounted to the patients as projected by the Healthcare Financial Management Association, said Ms. Rock. She said that for the past years, surgery centers have often turned a blind eye to the patient's duty and recommends they carry out a root private collections policy.

Don't hesitate to use technology

Since we are now in the 21st century and the surgical technology has advanced and is continuing to be, according to Ms. Rock that switching to high-tech billing practices will be the key to ASCs' success. "You cannot keep staffing for everything carriers are requiring today," she said. "Using automated registration tools, patient portals to eliminate calls [and other automated services] will help reduce staff expenses and increase cash."

Keep implants in mind

As the ASCs continues to add new equipment and medical products to their surgical force, every new piece of device is now with a new CPT code in it. "It's critical coders vet out the information provided by implant and technology vendors to fully understand which codes Medicare allows, and which it does not," said Alison Kuley, CPC, a senior spine coder. She also suggested the coding staff to thoroughly study proper coding practices for each new medical instrument to guarantee claim approval. This thing is yet another challenging area-implant for coders.

Takeaway

An array of faulty coding and billing is such a pain in the ass. Many medical practitioners cannot tolerate such errors as the increased patient financial responsibility pressures the cash rate. But with the help of some preventive measures and ways for improvement stated above, the various hindrances to proper coding and billing that the ASCs are facing can be lessened or avoided to ensure a successful reimbursement.