Learn about the Coding Guidelines, NCCI Edits and Policy Manual for Orthopedic Claims

Event Information
Product Format
Prerecorded Event
Lynn M. Anderanin, CPC, CPMA, CPPM, CPC-I, COSC
Conference Date
Tue, Nov 28, 2017
60 minutes
Product Description

Understand Insurance Carrier Policies and CPT® Guidelines to Submit Bullet Proof Appeals for Orthopedic Claims

Many coders are familiar with coding for orthopedics, but how well are the guidelines and policies known to reduce denials that cause delayed reimbursement? Not only do CPT® guidelines apply to orthopedic claims, but separate insurance carrier policies also apply. Coders must be aware of these guidelines and policies, especially to dispute denials received in error.

Join this session, where expert speaker Lynn M. Anderanin, CPC, CPMA, CPC-I, CPPM, COSC, will discuss the current guidelines and policies of different insurance carriers and will also look at the guidelines and parentheticals in CPT® that instruct coders about the appropriate way in which codes and modifier should be reported. Lynn will review CPT® guidelines, NCCI edits and policy manual, as well as insurance carrier policies that should be used for coding orthopedic claims.

By attending the session, you will learn to utilize the coding tools available at no cost to report the appropriate codes and modifiers. You will understand what needs to be documented to have claims clean on the first submission, and how to apply guidelines and policies to be able to dispute denials received in error. When all the coding tools are applied in coding, and the documentation supports the coding, the insurance carrier should be adjudicating the claim allowing for proper reimbursement.

At the end of the session, you will be able to not only submit claims clean and appropriately the first time for timely payment, but you will also be able to apply the rules and guidelines when the insurance carriers do not process the claims correctly, and submit bullet proof appeals written based on the guidelines and policies of the industry, not allowing insurance carriers to deny claims that should have been paid.

Session Highlights

  • CPT® parentheticals and guidelines found in the musculoskeletal system (20000 codes)
  • CMS NCCI policy manual general guidelines that should be applied to orthopedics
  • CMS NCCI policy manual guidelines specifically for the 20000 and 60000 CPT® codes
  • Cigna policies related to musculoskeletal system procedures
  • Aetna policies for medical necessity for common knee arthroscopy codes
  • Understanding symbols used in the CPT® manual that affect code assignment
  • Modifier usage and the over-use of modifier 59
  • Requesting from insurance carriers their policies when a denial is received
  • Reporting issues to the State Insurance Commission
  • Working with providers on documentation needed to assist in proper reimbursement

Session Agenda

  • CPT® guidelines for fractures
  • E/M services and a minor procedure
  • Hip arthroscopy
  • Non-payable code combinations
  • Hip hemiarthroplasty
  • Surgery: Musculoskeletal system CPT codes 20000-29999 for NCCI policy manual for Medicare services

Who Should Attend

  • Orthopedics
  • Podiatry
  • Coders
  • Surgery schedulers
  • Billers
  • Managers or administrators
  • Providers

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

Lynn Anderanin - Orthopedic Guidelines Expert for ICD 10

Lynn Anderanin, CPC, CPMA, CPPM, CPC-I, COSC, is the  Sr. Director of Coding Education for Healthcare Information Services, a physicians revenue cycle management company. She has over 35 years experience in all areas of the physician practice, and specializes in Orthopaedics.  Lynn is currently a  workshop and audio presenter. She is a  former member of the American Academy of Professional Coders (AAPC) National Advisory Board, and has served...   More Info
More Events By The Speaker

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