This 2022 JAAOS review teaches residents and new attendings the mechanics of orthopaedic billing and coding from first principles. It covers how RVUs are calculated and converted to dollars, how outpatient E/M codes are selected under the 2021 rules, and what triggers a compliance audit. The goal is to address a gap: formal billing education is absent from most orthopaedic residency programs.
Billing and coding knowledge is largely absent from orthopaedic residency training, yet documentation errors — not clinical errors. Are what trigger RAC audits and claim clawbacks.
For every outpatient encounter, use the MDM grid: identify the problem complexity, the data you reviewed, and the risk of your management plan. Meeting 2 of 3 elements at a given level is what justifies the code. Not how many organ systems you examined.
Before any total joint arthroplasty, confirm your note explicitly documents failed nonsurgical management for at least 3 months (or a clear reason why that criterion doesn't apply). That single documentation habit prevents the most common Medicare clawback scenario in elective orthopaedics.
When billing arthroscopic procedures, verify the NCCI bundling rules before adding secondary codes. Billing 29877 alongside 29880 is a textbook unbundling error that flags your claims for audit.
This 2022 JAAOS review teaches residents and new attendings the mechanics of orthopaedic billing and coding from first principles. It covers how RVUs are calculated and converted to dollars, how outpatient E/M codes are selected under the 2021 rules, and what triggers a compliance audit. The goal is to address a gap: formal billing education is absent from most orthopaedic residency programs.
Billing and coding knowledge is largely absent from orthopaedic residency training, yet documentation errors — not clinical errors. Are what trigger RAC audits and claim clawbacks.
For every outpatient encounter, use the MDM grid: identify the problem complexity, the data you reviewed, and the risk of your management plan. Meeting 2 of 3 elements at a given level is what justifies the code. Not how many organ systems you examined.
Before any total joint arthroplasty, confirm your note explicitly documents failed nonsurgical management for at least 3 months (or a clear reason why that criterion doesn't apply). That single documentation habit prevents the most common Medicare clawback scenario in elective orthopaedics.
When billing arthroscopic procedures, verify the NCCI bundling rules before adding secondary codes. Billing 29877 alongside 29880 is a textbook unbundling error that flags your claims for audit.