The new year is finally here, and with it several changes to CPT® codes—314, in fact. However, orthopedists won’t see too many new codes focused on their practices. Instead, the changes they do see reflect changing trends in orthopedics, mainly the rising preference of musculoskeletal (MSK) ultrasounds over magnetic resonance imaging (MRI). Changes in practice means changes in codes, which have significant reimbursement repercussions that require close attention from physicians and coders alike.
As part of this year’s ProfEdOnDemand 2018 Coding Updates Virtual Boot Camp, orthopedic coding expert Margie Scalley Vaught outlined upcoming orthopedics coding changes, including modifications to coding for shoulder surgical procedures, new radiology codes and updates to Medicare policies. With all the misinformation and confusion on how the new and revised codes should be used, Vaught skillfully guided coders and physicians through the changes they will need to implement in their practices to receive proper reimbursement this year.
The Appeal of Ultrasound
As orthopedic practices look for more ways to better serve their patients while cutting down on costs, the use of MSK ultrasounds has increased, albeit somewhat slowly in recent years. Although still widely associated with radiologists and obstetricians, orthopedists have made note of the advantages ultrasounds offer. According to physicians Hirahara and Panero, these benefits include:
- Lower cost and comparable results when compared to MRIs
- Portable machines that don’t restrict patients to a confined space
- Saving time and money by not requiring a second appointment with a radiologist at a different location
- No limitations (e.g., metal parts, pacemakers, claustrophobia, obesity) on which patients can undergo ultrasounds
- Can show tears in muscles, tendons and ligaments, as well as if soft tissue is damaged, normal or diseased
- Can show inflammation, nerve disorders or the presence of foreign bodies or infections
Complete vs. Limited Examinations
When it comes to coding for ultrasounds, two codes of focus (76881, 76882) highlight how orthopedics is changing by incorporating more ultrasound technology. The switch from examinations being MRI-focused to more ultrasound-focused is a significant change that can trip up even the most experienced coders. In order to submit proper claims, it’s important to understand the differences between these revised codes.
For 76881 and 76882, the phrase “extremity, nonvascular” was eliminated for 2018, with wording provided to further distinguish between the two codes. The two codes are now defined as:
- 76881: Ultrasound, complete joint (i.e., joint space and peri-articular soft tissue structures) real-time with image documentation
- 76882: Ultrasound, limited, joint or other nonvascular extremity structure(s) (e.g., joint space, peri-articular tendon(s), muscle(s), nerve(s), other soft tissue structure(s), or soft tissue mass(es)), real-time with image documentation
The main difference between the two codes is that 76881 is for a complete procedure examining the joint and surrounding soft tissues. For an ultrasound examining anything less, code 76882 should be used. When coding for either 76881 or 76882, coders should remember that modifier 50 cannot be used with either code, and an ultrasound cannot be performed on the same joint on the opposite side of the body just for comparison purposes.
After each ultrasound, the following information should be kept in the patient’s medical record:
- Images of the areas scanned, marked with the exam date, identification of the patient, and the orientation of the image
- Documentation on any variations, with measurements
- A formal interpretation of the images
Meeting the Requirements for Reimbursement
When it comes to ultrasounds, physicians will also need to understand the requirements of each payer, as well as always demonstrate the medical necessity of each ultrasound.
Medicare Part B will typically reimburse orthopedists for ultrasounds that are medically necessary, as long as ultrasounds are within the scope of the orthopedist’s license.
When it comes to private payers, things can be trickier. Prior to providing reimbursement, certain payers may require that the professional who performed the ultrasound have specific accreditations or certifications related to ultrasound. Because of this, physicians should, prior to providing services, contact payers and be up to date on what may be required of them in order to receive the reimbursement they deserve.
Adjusting to Changing Practices
Ultrasounds are a time- and cost-effective way to provide quality care for patients. As they become more common in orthopedic practices, physicians and coders alike will need to understand the details of each code and modifier in order to submit proper claims and receive well-deserved reimbursement. The complexity of these regulations are best explained by orthopedic coding specialists who are fully up to date on the latest trends and requirements, making ProfEdOnDemand’s 2018 Coding Updates Virtual Boot Camp webinars an ideal resource for even the most seasoned coders.
