definitions Overview coding and billing involves a system of rules and guidelines by which orthopedic surgeons can describe what was treated and in what manner it was treated Definitions Common procedural terminology (CPT®) a 5 digit alphanumeric code used by insurers to help determine the amount of reimbursement that a practitioner will receive for services provided login to view 4 more bullets Relative Value Units (RVU) a unit value assigned to each CPT code derived by four factors International Classification of Disease -10 (ICD-10) a clinical cataloging system developed by the World Health Organization (WHO) used to define and classify diagnoses ICD-10 ICD-10 provides coding structure to diagnosis alphanumeric seven-digit codes utilized allows description of: login to view 8 more bullets Current Procedural Terminology (CPT) CPT codes are assigned to specific services including operative procedures, nonoperative care, and minor procedures (injections/aspirations) operative procedures codes are all-inclusive and include approach, procedure, closure, splinting, etc. codes are associated with a global period (0, 10, or 90 days) during which all associated services are considered within the package of care Modifiers a 2-digit code used to indicate a special situation -22 modifier login to view 1 more bullet -24 modifier login to view 1 more bullet -25 modifier login to view 1 more bullet Evaluation and Management (E&M) Location of service and level of service location outpatient login to view 11 more bullets emergency department hospital login to view 1 more bullet level of service (1-5) component-based login to view 3 more bullets time-based login to view 2 more bullets Documentation detail in note must match requirements for location and level of services that are billed for Global Period (90-Day) Overview single payment for care associated with a surgical procedure What is included preoperative care preoperative visits and work OR preparation (patient marking, positiong, prep, drape) operative care skin to skin work immobilization and bracing application of immobilization or bracing in the OR postoperative care inpatient visits (postoperative progress notes) postoperagive visits for up to 90 days login to view 1 more bullet What is not included postoperative care diagnostic tests and procedures (e.g., CBC on postop day #1) immobilization and bracing application of immobilization outside of the OR different conditions visits for separate problems evaluation by physician part of a different group additonal operations reoperation for complications from initial procedure (e.g., infection) staged procedures (e.g., front-back spine surgery) Coding errors ICD-10 diagnosis code should support and justify the corresponding E&M and CPT codes for services provided Errors seen as fraud regardless of whether intentional or unintentional services billed were not provided at all services billed were not provided by billing physician services billed were provided but not supported in documentation responsibility ultimately falls on the billing physician