Coding basics for orthopaedic surgeons

Abstract

Knowledge and correct reporting of Current Procedure Terminology (CPT) coding is part of a physician's education and requires continuing education similar to other aspects of patient care. Upcoding and downcoding have potentially devastating effects on the practice of orthopaedic surgery. The history of CPT and rationale for development of the current coding and reimbursement methods are described. This report outlines the basic coding rules and points out some of the more frequent areas of neglected or incorrect coding. The use of CPT code modifiers, add-on codes, extended visits, and consultations are areas of particular concern. The orthopaedic surgeon must be extensively involved in the coding of office and hospital patient encounters. Some studies have indicated up to a 25 % reimbursement loss if the physician does not code his or her own patient care activities.