As the leading orthopedic billing company, Apache Health determines what if any changes in orthopedic billing will be enacted for the coming year every December.  Apache then writes up the changes and distributes this to our clients and educates them on the forthcoming changes, as well as any implications on their reimbursement.

 

This article specifically covers the changes to foot and ankle orthopaedic billing.  There are some significant changes for 2017.  Most financial impacts are negative.

 

Hallux Rigidus Correction

Revised Code:

CPT 28289 – Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant.

 

New Code:

CPT 28291 – Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant.

 

Deleted:

CPT 28290

 

Important to specify in your documentation now whether the procedure was with or without an implant.

 

Financial impact

It is important for any capable orthopedic billing service to provide its clients with information about upcoming reimbursement changes that significantly impact on its clients.  Following are the old and new fee schedules, as well as the percent changes for 2017.

Code 2016 2017 Change
28289 $620.52 $525.21 -15.4%
28291 $538.76 NA

*Facility Rates

The lowered Medicare reimbursement for 2017 represents approximately a 13%-15% reduction in the Medicare fee schedule.  For simplicity we have noted here just one Medicare locality fee schedule, which is in Orange County, California.  The change will be comparable across the country, although not exactly the same nominal amounts.  Please feel free to contact us to find out exactly how much the change will be for your state or locality.

 

Hallux Valgus Correction

Revised codes:

CPT 28292 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method

 

CPT 28296 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method

 

CPT 28297 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method

 

All three have added the words “any method” into their CPTs, which is why they have deleted the codes denoted below.

 

Deleted:

CPT 28293 and 28294

 

New Code:

CPT 28295 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method.

 

Proper Code assignment will require greater clarity on operative reports.  Site is very important on the toe – distal, proximal, etc.  Note that the AMA manual has input this code out of sequence.  We increasingly see that there are codes out of order, which makes finding them increasingly difficult when doing orthopedic coding.

 

 

Financial Impact

Code 2016 2017 Change
28292 $685.19 $546.67 -20.2%
28295 $604.07 NA
28296 $590.15 $580.94 -1.6%
28297 $656.35 $678.40 3.4%

*Facility Rates

 

Revised Codes:

CPT 28298 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method.

 

CPT 28299 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method.

 

*Proper Code assignment will require greater clarity on operative reports.

 

Financial Impact

Code 2016 2017 Change
28298 $571.85 $558.40 -2.4%
28299 $760.90 $651.89 -14.3%

*Facility Rates

 

About Apache Health

Apache Health is a revenue cycle management (RCM) analytics, benchmarking, and auditing company. The founders of Apache formerly ran a large RCM company that was acquired by a private equity group in a rollup. Apache’s predictive analytics will benchmark billing performance and project exactly how much more revenue you should earn from your existing volume of patients.  Using many factors and a blend of artificial intelligence and specialty specific benchmarks, the model projects whether changing the billing process would improve collections for your particular mix of procedures and payers. Apache Health can help you evaluate whether to outsource the billing, determine which billing company to select to maximize performance, or track in-house billing performance improvement over time. For more information contact:

Sean McSweeney

Apache Health

www.apachehealth.com

888-422-5514