2018 TOA Annual Conference Coding Course

Orthopaedic Coding Course
9:00 a.m. – 3:00 p.m.
Friday, April 13, 2018

Created for orthopaedic surgeons and billing/coding staff members, Margi Maley of Karen Zupko & Assoc. will teach this all-day course that will focus on the latest orthopaedic coding updates.

Learning Objectives:

  • Choose the correct E/M categories for office and hospital services.
  • Define a “procedure to procedure edit”
  • Differentiate CPT code definitions from NCCI procedure-to-procedure edits and narrative guidelines.
  • Apply E/M and surgical modifiers so that reimbursement is optimized and accurate.


Certification of TKA for inpatient surgery- are you getting denied?

Fact vs Fiction

Medical Necessity-What is it? Why is it SO important?

The role of diagnosis coding in medical necessity

Anatomy of a Payment Policy- are you getting denials for Arthroscopy?

Do you know why?

E/M Categories of Service and when to use them.

New vs Established Patient

What is a consultation? What about Medicare

What do you use when you go to the ER?

E/M Levels of Service and how to document them.

History, Physical Examination, Medical Decision Making

Any Update on the simplification of these guidelines?
Global Surgical Package

Pre-operative H&P – can this be reported?

E/M modifiers 24,25,57

Modifier-25 reductions and denials-What to do?

Are the payors going to reduce my E/M service by 50% when I do an injection?

CPT Rules, Medicare Rules, AAOS Global Service Data Guide
Fracture Care and fracture package

ER, Office and Outpatient hospital.

Is there a difference in reporting fracture care?

Medicare rule for fractures treated with a single cast

Modifier 59 VS 51: Finally explained so you can understand it.

Most common orthopaedic examples.

Modifier 58: Staged procedures
Modifier 78: Return to the OR to treat a complication
Modifier 79: Unrelated procedure in the global period
Modifier 22: Unusual Service
Modifier 52: reduced Service