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Getting Familiar with CPT Codes for Musculoskeletal System

Jul 27

Although medical billing services is independent processe, they are both required for providers to be paid for healthcare services. Medical billing employs these codes to generate insurance claims and patient bills by extracting billable data from the medical record and clinical documentation. 

Medical billing services and medical coding services come together in the process of creating claims to create the foundation of the healthcare revenue cycle. 

Depending on the intricacy of the services provided, how claim denials are handled, and how organisations collect a patient's financial responsibilities, the medical transcription services and coding cycle can last anywhere from a few days to several months. 

The majority of disabilities in the US are caused by musculoskeletal conditions, which have a significant influence on longevity and quality of life. They cover a wide range of problems that limit daily activities because of damage to the joints, bones, tendons, muscles, ligaments, or pain from diseases of those structures. The aging process is linked to or complicated by many of these illnesses.

Locating the Appropriate Procedure Codes in the Musculoskeletal Section

If the appropriate code cannot be found under an anatomic site heading (e.g., head), refer to the codes following the “general” section at the beginning of the musculoskeletal system. Main Headings in the musculoskeletal section of your CPT® manual for body parts follow, for the most part, this order, with some additions: 

  • Incision procedures 
  • Excision procedures 
  • Introduction or removal 
  • Repair, Revision and/or reconstruction 
  • Fractures and/or dislocations 

The codes in the musculoskeletal system of the CPT manual cover procedures to the bones, muscles, tendons and soft tissue. The musculoskeletal system has key phrases that a coder must recognize and understand for an accurate code to be assigned. It is important to have an understanding of anatomy and physiology to avoid coding errors. In the CPT musculoskeletal section of the manual, there are extensive notes on the proper coding of fractures/dislocations. These notes are followed by the following headings: 

  • General 
  • General procedure codes and excision, introduction and removal 
  • Halo application codes 
  •  External fixation codes 
  • Replantation codes 
  • Grafts (implants) 
  • Other procedures 
  • Procedures on the head 
  • Procedures on the neck 
  • Procedures on the back and flank 

Remember to check under the anatomic sections for excision or incision procedure codes before defaulting to the 10000 series codes.

A recent audit by the Department of Health and Human Services’ Office of the Inspector General (OIG) revealed that insufficient or lack of documentation was the number one error when medical records were reviewed. Physicians can anticipate greater attempts through the federal government to undertake post-payment evaluations in search of proof to substantiate billed expenses and medical necessity concerns as a consequence of these audits. For a far more complete investigation, a targeted audit would be utilized to identify doctors who might have filed false claims.

Medicare Preferences for a Doctor's Paperwork

  • Medicare anticipates that the supporting documentation will be produced either at the moment of the service or soon after.
  • For clarity, error detection and correction, the inclusion of data that was not previously accessible, and if certain extraordinary circumstances precluded the compilation of the record at the time of delivery, late additions within an acceptable duration frame (24–48 hours) are permitted.
  • The patient's medical file cannot be changed. Mistakes must be comprehensibly repaired in order for the carrier auditor to determine where they originated. These modifications or inclusions should be legibly signed or initialled, dated, and ideally timed.
  • Every note is independent of the others, therefore the executed services should always be listed right away.
  • Medicare may take into account delayed written justifications for clarification. According to some carriers, they could not be employed to add and validate services that were billed but undocumented at the moment of provision or to retroactively support medical necessity. Medicare anticipates that the medical record will be self-sufficient, with the initial entry verifying that the treatment was provided and that it was medically required.
  • Every submission must be clear enough for a second reader to be able to review them in a meaningful way.
  • Every note needs to be signed, dated, and ideally timed by the author. Initials are permissible in the workplace so long as they properly recognize the author.

General Directions

  1. The largest portion of the CPT surgical field is the musculoskeletal subsection. The organization is determined by the anatomical site (beginning with the head ) and then by the actions taken. Each part contains a wealth of notes that the developer must read in order to access the correct code. For instance, the chapter's introduction includes a detailed description of open, percutaneous, and closed therapies.
  2. Study the descriptions of the codes. The phrases "with fixation," "with manipulation," "with anesthetic," etc. are frequently used. These specifications will frequently dictate the code that is assigned.
  3. Watch out for phrases like "each digit," "every," "single," "one toe," and so on in the CPT codes. Depending on this data, you might need to apply various codes or modifiers.
  4. Prior to issuing a code depending solely on the CPT index, make sure you thoroughly examine the actual section. Regarding various processes, the CPT index may be inaccurate and lacking.

Orthopedics guide to changes in the codes relating to the Musculoskeletal system

The AMA as well as CPT have simplified the orthopedics coding procedures a bit. As a result, the chapter that contains the codes for the musculoskeletal system had about 89 alterations. New codes were also established to help people comprehend the situation better. Not to mention that about 8 of the new codes' 31 descriptions of arthroscopic surgery are correct. This indicates that the unquoted process codes for the operations are no longer required. The primary difficulty that happens in the future is adapting contact forms and billing sheets to the newer coding environment. The orthopedics coding routines are covered in this page along with a variety of outdated, amended, and new codes. On the contrary, there seem to be codes that have even seemingly insignificant alterations done to them that alter their very character. For example, even the smallest grammatical modifications and punctuation might be rather difficult. Take a look at code 20225 as an example. During the orthopedics coding procedures, this code indicates the biopsy bone trocar. This effectively informs the carrier that the physician initially did a thorough bone biopsy and that it was not limited to the femur.

Minor adjustments were made to the code group 21182-21184. Fundamentally, this group worked on the restoration of orbital walls. The fibrous dysplasia would serve as an illustration of this. The code options in this scenario are also based on the size of the bone grafting region. The measurements were first provided in centimeters.

However, with the adjustment, measures are now reported during the orthopedics coding routines in square centimeters. Additionally, codes from the 20000 series under the injection area were included. The new adjustment enhances the injectable level coding and enables the reporting of injections into the carpal canal and injections into trigger points. Initially, the orthopedics coding process's code 20526 indicated the therapeutic injection. Corticosteroids used in local anesthetic are one example. The code 20550, which indicated the injection related to the tendon cyst, is another significant one in this context. Additionally, the tendon insertion or origin was documented by code 20551.

Preparing for the CPC exam

  • The musculoskeletal system is covered by around 10 questions on the CPC exam, albeit this number is only an estimate.
  • Let's look at some particular items to look out for during the CPC exam as dissecting the whole musculoskeletal system would require a separate eBook.
  • A person may sustain a wide range of distinct injuries under the heading of musculoskeletal. It's critical to be aware to distinguish between wounds that occur on the same portion of the body but are comparable but distinct. For instance, regardless of the idea that they could result in a similar apparent diagnosis and, very likely, a similar level of discomfort in the patient, a broken finger and a displaced finger are not the same.
  • A bone that has fractured has broken, whereas a bone that has dislocated has moved out of place. The bone remains present but misplaced in a dislocation. 

A few fundamental, crucial vocabulary pointers. Osteo refers to a bone, whereas arthro refers to a joint. You must understand the distinctions between -ostomies, -otomies, and ectomies, amongst other surgical vocab words, as with other Surgery codes. You should be familiar with positioning terminology like anterior, inferior, superior, and posterior that describe where object is in space. For a more complete explanation of physiology and anatomy concepts, 

The vertebrae is one of the musculoskeletal system's most intricate components. Remember that treatments on the spine described in the musculoskeletal part of Surgery relate to the discs that maintain the spinal cord rather than the spinal cord itself. Making that distinction is crucial.

If you find a crucial term that indicates a topic that relates to the vertebrae, double-check to determine if you ought to be focusing on the spinal column and its connection to the central nervous system or the vertebrae of the spine. The Surgery section's Nervous System area is where you'll find procedures that work on the central nervous system, such as relieving strain on the spine. Utilizing the vertebral numbers, you can move around the spine. 12 thoracic vertebrae, 5 lumbar vertebrae, and 7 cervical vertebrae make up the spine. The C6 might be the 6th cervical vertebrae since each of these is identified through alpha and sometimes a number.

Basically, the musculoskeletal portion of Surgery covers anything having to do with the body's muscles and bones. The musculoskeletal area is where the patient goes if they need to get a bunion eliminated. The musculoskeletal division includes bone aspirations, bone grafts, tendon restoration, and joint reconstruction. It is crucial to purchase some flashcards and start studying so that you can travel directly to the correct section of the subchapter by memorizing the correct phrases for the part of the body.

A handful of experimental procedure codes are given at the conclusion of musculoskeletal, just as in many other subcategories of Surgery. The standard suspects in "scopes," such as endoscopes and arthroscopes, that inject a camera into a joint, are present. You might well be aware of athletes who have arthroscopic procedures. That could be categorized under musculoskeletal.