How Our Orthopedic Medical Billing Software Works:
Orthopedic Client in Florida
Vice President of Information Technology
Trusted By
Customization and Control
You and your team are already experts at navigating the complex world of revenue cycle management. We’ll work with you to identify critical areas where custom rules can dramatically reduce the burden of manual effort by automatically correcting routine billing errors.
Custom Orthopedic Rule Examples
The Challenge
The GP modifier for outpatient physical therapy is missing.
The Solution
When billing Medicare for physical therapy services rendered under a physical therapy plan of care, a GP modifier is required. This rule automatically adds the necessary modifier.
The Challenge
The diagnosis code for aftercare following joint replacement surgery also needs a diagnosis code identifying the joint.
The Solution
When billing 99024 with a primary diagnosis of aftercare following joint replacement surgery (Z47.1), a diagnosis code is needed to identify the joint (Z96.6). This rule flags the encounter for review so a coder can determine the appropriate code and update the encounter.
The Challenge
The diagnosis is side-specific (affecting the right or left side of the body) and needs a laterality modifier.
The Solution
When billing with a diagnosis code that specifies left side or right side, this rule automatically adds the appropriate LT or RT modifier.
The Challenge
The CQ modifier for outpatient physical therapy services by a physical therapist assistant is missing.
The Solution
When billing Medicare for physical therapy services rendered by a physical therapy assistant (PTA), a CQ modifier is required. This rule automatically adds the necessary modifier.
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The Challenge
The GP modifier for outpatient physical therapy is missing.
The Solution
When billing Medicare for physical therapy services rendered under a physical therapy plan of care, a GP modifier is required. This rule automatically adds the necessary modifier.
-
The Challenge
The diagnosis code for aftercare following joint replacement surgery also needs a diagnosis code identifying the joint.
The Solution
When billing 99024 with a primary diagnosis of aftercare following joint replacement surgery (Z47.1), a diagnosis code is needed to identify the joint (Z96.6). This rule flags the encounter for review so a coder can determine the appropriate code and update the encounter.
-
The Challenge
The diagnosis is side-specific (affecting the right or left side of the body) and needs a laterality modifier.
The Solution
When billing with a diagnosis code that specifies left side or right side, this rule automatically adds the appropriate LT or RT modifier.
-
The Challenge
The CQ modifier for outpatient physical therapy services by a physical therapist assistant is missing.
The Solution
When billing Medicare for physical therapy services rendered by a physical therapy assistant (PTA), a CQ modifier is required. This rule automatically adds the necessary modifier.
Have a complex orthopedic billing or coding challenge you want to automate?
Why Choose the Revenue Cycle Engine?
Our technology integrates with systems you already use. Working seamlessly on the front end of your process, RCxRules reviews each and every charge for coding completeness and accuracy immediately after it leaves your EMR, before a claim is created.
Data Entry Team Lead, Pacific Cataract and Laser Institute