Expert Medical Billing for Orthopedics in New Jersey
Orthopedic medical billing in New Jersey demands precise documentation and accurate calculations throughout a patient’s visit—before, during, and after. Serving New Jersey, our billers specialize in addressing the unique challenges of orthopedic billing with expertise and efficiency.
We stay current with the latest billing reforms and technologies to minimize claim rejections and enhance your practice’s financial health. Our services include:
- Accurate coding for diverse orthopedic procedures
- Both electronic and paper billing options
- Regular code audits to ensure correct coding
- Comprehensive account analysis to prevent cash flow issues
- Persistent follow-ups with payers for pending payments
- Daily, weekly, and monthly financial reporting
The Most Common Orthopedic Billing Denials Include:
- Missing Information (e.g., date of accident, incorrect patient information)
- Timely filing claims (claims not submitted on time)
- Wrong insurance billed (e.g., new policy number)
- Incorrect place of service code
- Incorrect diagnosis (ICD10 code not medically necessary)
- Missing or Invalid Modifiers
- Preauthorization of correct CPT/Procedure code with insurance carrier
Key Billing Insights:
Knee Bundles
Common unbundling errors involve shoulder and knee procedure coding. To avoid denials, you need to understand the payer’s definition of “compartment.”
The Centers for Medicare & Medicaid Services (CMS) and the AAOS recognize three compartments of the knee: medial, lateral, and suprapatellar. It’s inappropriate to append modifier 59 Distinct procedural service to unbundle surgical procedures performed in the same compartment(s).
- *Example 1: Never report both CPT 29880 Arthroscopy, knee, with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed and 29876 Arthroscopy, synovectomy, 2 or more compartments (e.g., medial or lateral), per the NCCI manual. Each code represents the same two compartments of the knee. Because a knee only has three compartments, one or both compartments involved in each procedure may overlap.
- For instance, if 29876 was performed on the same compartments as 29880, report only 29880. But if the provider performed the services in the suprapatellar compartment and either the medial or lateral compartment, report 29880 and 29875 Arthroscopy, knee, synovectomy, limited (e.g., plica or shelf resection) with modifier 59 appended. Modifier 59 is necessary because the suprapatellar compartment is separate from the medial and lateral compartments of the same knee.
Impeccable Billing and Coding Credentials
Our New Jersey orthopedic billing services are provided by specialists with outstanding credentials:
- Certification: American Association of Professional Coders (AAPC)
- Software Proficiency: Experienced with EHR systems, including NextGen Healthcare, Epic, AthenaOne, Modernizing Medicine, HealthPac, Intergy, eClinicalWorks, Athenahealth, and Practice Fusion.
- Coding Expertise: Proficient in CPT, HCPCS, and ICD 10-CM coding per CMS guidelines.
- Carrier Experience: Proven success with major commercial carriers such as United Healthcare, WellPoint, Aetna, Humana, Cigna, Medicare, Workers Compensation, and Blue Cross Group.
Enhancing Your Revenue Management Cycle
Our billing process optimizes each step of the patient cycle—from accurate CPT and ICD10 coding, applying appropriate modifiers, claim submission, payment posting, follow-up on unpaid and denied claims, and appeals.
Our services—accurate charge capture, detailed procedure coding, electronic claim submission, patient billing, multi-tiered appeals, denial management, and compliance—simplify your revenue cycle, improve collection rates, attract more patients, and support medical research and development.
Orthopedic practices in New Jersey that engage MedPro Services experience significant improvements in both practice revenue and clinical efficiency.