AAOS Now, August 2010
Implementing contract negotiations: Let the games begin
Once you know the rules, you’re positioned to win Editor’s note: This is the final article in a series devoted to examining various aspects of negotiating payor agreements. “Negotiating contracts” (June) and “Making your pitch for higher payments” (July) are the first two articles in the series. Once you’ve assembled the data you need and sent your proposal letter to payors, you’re ready to begin the negotiating process.
Joint injections and CCI edits
Follow CPT rules for proper payments Recently, a coder for a sports medicine group submitted the following question regarding the administration of a joint injection for pain management at the end of the case: “A joint injection (20610) is listed as a component code of a meniscectomy procedure (29881) but the Correct Coding Initiative (CCI) edits indicate that the edit may be overridden with the use of the 1 modifier when appropriate.
Updating guidelines and tables for office E/M coding
Editor’s note: This is the second article updating information first provided in the May 2007 edition of AAOS Now. This article covers components of the orthopaedic evaluation, while the previous article covered the issues of new and established patients and consultations. The orthopaedic evaluation is made up of three key components: the history, the physical examination, and medical decision-making.
Anatomy of an EMR contract
Make sure these areas are covered to your satisfaction “I’m in the business of shifting risk,” attorney Steven M. Harris, Esq., told attendees at the recent AAOS Electronic Medical Records (EMR) and Other Technologies: Revolutionary Change in Orthopaedic Practice course. “The contract apportions risk between party one and party two.” Mr. Harris advised his audience to involve professionals—such as EMR consultants, technology advisors, and legal advisors—early on.
Never say “never events”
Can we reframe them to support patient safety? Confusion persists about the conditions commonly referred to as “never events” and those deemed as “nonreimbursable serious hospital-acquired conditions” (HACs) by the Centers for Medicare & Medicaid Services (CMS).
What went wrong here?
By Jeff Varnell, MD, FACS Analyzing a medical liability claim Editor’s Note: Articles labeled Orthopaedic Risk Manager are presented by the Medical Liability Committee under the direction of contributing editor S. Jay Jayasankar, MD. Articles are provided for general information and are not legal advice; for legal advice, consult a qualified professional. E-mail your comments to firstname.lastname@example.org or contact this issue’s contributors directly.
Avoidability: An alternative standard for medical liability
Will adopting a different standard help? Medical liability systems aim to compensate the injured, deter and/or prevent recurrence of the error, and deliver corrective justice. Negligence, the U.S. standard for liability, is established through an adversarial litigation system that is costly and emotionally demanding to all, takes an average of 5 years for resolution, and achieves these aims poorly. Tort reform—especially limits on noneconomic damages—controls costs.
Managing your practice ahead of the curve
Strategize now to maintain your independence The reality of healthcare reform is challenging orthopaedic physicians and their practices to prepare for change. Although the real changes (bundled payments, the establishment of Accountable Care Organizations) are expected to take effect between 2012 and 2014, groups must begin to prepare now to meet the additional emphasis on accountability, quality, outcomes, and consequences for performance.
PRP gets CPT Category III code
On July 1, 2010, the American Medical Association (AMA) Current Procedural Terminology (CPT) introduced a new category III (new technology) code for the performance of platelet rich plasma (PRP) injection procedures. The specific wording of the code follows: “0232T—Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed (Do not report 0232T in conjunction with 20550, 20551, 20600-20610, 20926, 76942, 77002, 77012, 77021, 86965.