Is spine surgery billing and coding critical for various clinical specialties like
Neurology, Radiology,
Orthopedics, pain management ? To follow
timely revenue payments between complicated spine surgery and procedures, ensure if ambulatory
surgery centers have submitted proper claims along with accurate medical codes.
Spine related issues can be due to nerve root compression, facet arthropathic, intervertebral discs.
Diagnostic spine surgery and procedures include, lumbar puncture, myelography, discography, biopsy
and aspiration along with plain film radiography, nuclear medicine, CT, and MRI scans.
Let’s check out 5 tips to reduce Spine Surgery medical billing and coding complications.
1.Acquire Accurate Documentation:
Obtaining complete documentation for spine procedures and surgeries ,necessary operative notes, list
of anesthesia and medication is very essential to begin with coding.
Ensure if all the documentation is set accordingly before starting to code. Many challenges are
involved in the process, more specifically when there’s more than one procedure.
Make sure if you are assigning the level of specificity for any spine surgery or procedure with
accurate and matching modifiers.
Few claims are denied just because the modifiers aren’t correctly attached and are not affixed to
secondary and tertiary procedures.
These spine surgeries are expensive and time consuming from the medical billing and coding team’s
point of view. The submitted documentation needs to be more specific for timely reimbursements.
Medical billing and coding companies and healthcare professionals must educate themselves as spine
surgery medical billing and coding practices are critical and set to become more stringent in the
upcoming years.
It’s important how healthcare professionals note their spinal procedures or surgeries. They have to
be more specific about interpretation and use of certain words in reports to avoid ambiguity.
Physician queries are also possible when the given notes aren’t clear and accurate.
2.Prevent Usage of Unlisted Coding:
When healthcare professionals use unlisted codes while billing the claims, it can be really
challenging as unlisted codes appear to “experimental ” for insurance companies.
Therefore insurance companies fail to reimburse revenue for experimental treatment including
outpatient and inpatient settings.
While using unlisted codes, ensure if insurance companies cover them under certain policies . Most
of them easily identify non covered claim on their sites.
This process won’t help healthcare professionals in gaining their revenue back and moreover it
remains a burden for patients who have to pay later on.
3.Closely Monitor Insurance Coverage Updates:
Spine surgeons and practitioner abruptly sometimes receive claim denials for the wrong coverage
surgeries or procedures those were earlier covered by insurance companies.
For instance, bio-materials such as new bio grafting materials are under non covered policy though
covered and recognized in the past.
It’s not the entire spine surgery or procedure, but just the bio-materials that were being denied in
many cases.
Such procedures were covered in applications for several years, but at present, they are considered
to be experimental and therefore, come under non covered.
It’s important to keep an eye on the insurance company website for policy updates and make sure your
office staff gets notified of any changes, which might lead to claim denials.
4.Argue for Medical Necessity:
Medical billing and coding part definitely sets healthcare professionals in a hazardous path if
medical necessity isn’t paid by insurance companies. Insurance companies are majorly denying spinal
procedures based on medical necessity.
Insurance companies claim that spinal surgery isn’t medically necessary for a number of reasons,
including in circumstances where approval was predominantly granted in the early days.
There was class action settlement a few years back. “The Second Circuit Court of Appeals decided
that there were multiple cases where medical necessity is mentioned and required.
Encourage healthcare professionals to write the appeal letters for claims those were denied due to
medical necessity, as you do not want to leave that to the discretion of a non-clinician or non –
physician.
However for medical billing and coding, healthcare professionals cannot write the appeal letter of
medical necessity in simple and common language, which the practice staff can use.
5.Appeal Denied Claims:
Resubmitting claims and appealing them is the best way to get your money back. If the claim is
denied for the reason of medical billing and coding errors, correct the mistake and resubmit those
claims within a given time period.
Some insurance companies are trying to create bogus algorithms just to deny a spinal surgery
healthcare professionals performing spinal surgeries.
They don’t actually pay attention to the clinical notes and interrupt with excuses like surgery
isn’t indicated, when clearly the findings are shown.
Insurance companies do it hoping that the patient and spinal surgeon will give up and the surgery or
procedure won’t be performed.
It’s very essential to fight for the coverage and reimbursement rates from insurance companies for
the Preauthorization and receive a green signal for spine surgery.
Always keep in mind that pre-certification approval is in not a guarantee of payment in anyway. Once
the services have been rendered and when claim has been submitted for reimbursement, procedure for
revenue payments begins..
Hope you got necessary information on Spinal surgery and tips to follow for better medical billing
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