AANA Lab Course 907-Arthroscopic/Open Strategies - Hip Preservation-Billing and Coding in Hip Preservation Surgery-Cheyenne Brison, Karen Zupko and Associates

Video Transcription

Video Summary

Cheyenne Brinson, from Care and Zipco Associates, delivered an in-depth presentation on optimizing reimbursement for hip preservation surgeries, focusing on practical strategies for both private and hospital-based orthopedic practices. She emphasized the critical importance of thoroughly understanding and adhering to the specific medical necessity policies of various insurance payers, noting significant variability even within the same insurance family depending on state and plan. Using exact payer verbiage in documentation, especially when describing failed conservative treatment, is essential to securing initial authorization and avoiding denials.<br /><br />She highlighted the new role of entities like Evacor, which now manage surgical authorizations for many payers, and stressed the efficiency of electronic prior authorization systems over phone calls, with substantial cost savings and faster turnaround times. Brinson underscored the need for staff training and standardized operating procedures to ensure proper documentation, timely submission, and prompt communication—particularly when intraoperative changes require amended authorizations to prevent payment denials.<br /><br />Accurate coding was emphasized, including the appropriate sequencing of CPT codes (highest RVUs first), use of specific rather than vague diagnosis codes, and cautious application of modifiers like 59 and 22 to avoid audit risks. For unlisted procedure codes, she advised basing fees on comparable codes and clearly documenting distinctions for payer review.<br /><br />Patient financial responsibility was addressed through transparent communication, pre-surgery estimates including out-of-pocket costs, and offering payment plans or financing options such as Care Credit. Collecting deposits at the time of service was presented as beneficial for practice cash flow and patient satisfaction.<br /><br />Finally, denials were categorized mainly as administrative or documentation-related, with actionable steps suggested to reduce repetitive errors through denial tracking and proactive process improvements. Overall, Brinson’s talk provided a comprehensive roadmap to navigating the complex reimbursement landscape for hip preservation surgery, enhancing practice revenue while supporting patient financial clarity.

Keywords

Cheyenne Brinson

hip preservation surgery

reimbursement optimization

insurance payer policies

medical necessity

prior authorization

Evacor

electronic prior authorization

staff training

CPT coding

patient financial responsibility

denial management