CMS Updates Physician Assistant and Nurse Practitioner Billing

AAOSNow – May 2022
by Sarah Wiskerchen

In January, CMS introduced guideline changes to its Medicare reporting rules that impact PA/NP billing. These changes could require practices to modify how they report split/shared services. Previously, shared services were frequently reported in the name of a physician. Now, new rules determine who can report the services. Failing to comply with the new CMS rules will create compliance risks for physician practices.

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Commonly Asked Coding Questions in 2022

AAOSNow – March 2022
by Sarah Wiskerchen

In this column, KarenZupko & Associates addresses recently asked questions on coding for various orthopaedic procedures posed by orthopaedic surgeons, practice managers, and staff.

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Arthroscopy Coding for Major Joints - Shoulder

AAOSNow – March 2018
by Michael R. Marks, MD, MBA

An accurate understanding of coding rules increases likelihood of receiving appropriate payment
Correctly reporting and billing for arthroscopy services is often confusing.

Last month, AAOS Now reviewed the knee arthroscopy codes and outlined the appropriate use of modifiers. This month, the topic is coding for shoulder and hip arthroscopic procedures.

Arthroscopic shoulder procedures
The traditional coding rule about the shoulder is to consider the joint as one compartment. Due to continuous efforts by orthopaedic societies, a two-compartment (intra- and extra-articular) viewpoint is gaining acceptance. As a result, a few coding rules have changed. Intra-articular structures include the labrum, the long head of the biceps, a Bankart lesion, and the humeral and glenoid articular surfaces. Extra-articular structures include the rotator cuff (RC), the distal clavicle, and the subacromial space.

In 2017, the Centers for Medicare & Medicaid Services (CMS) made a significant change to the extensive débridement code (29823). There are now three situations in which this code can be billed if the extensive débridement portion of the procedure is performed in a separate area of the shoulder joint. This is similar to coding for the knee, which also has distinct anatomic compartments. The applicable codes are:

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New Physician Onboarding Checklist

by Cheryl Toth, MBA

Use this checklist to manage the orientation and onboarding activities for each new physician you hire. Ask for regular status updates – especially about the credentialing process. Items listed in each section are not necessarily in chronological order.