The Business of Medicine: Hospital-Based, Academic, Private Practice – Learning How To Succeed (2021 Annual Meeting)-The Business of Medicine: Hospital-Based, Academic, Private Practice

The Business of Medicine: Hospital-Based, Academic, Private Practice - Learning How To Succeed-Elkousy

Video Transcription

Video Summary

Hussain El-Koussi presents an overview of orthopedic and sports medicine reimbursement, focusing on maximizing payment through correct ICD-10 and CPT coding, documentation, and understanding bundling rules. He explains reimbursement is determined by the RBRVS system, with payments based on work effort, practice expenses, and malpractice costs, though reductions have occurred over time due to CMS cost controls and policies favoring primary care over procedural specialties. Orthopedic surgeons face declining reimbursements, code bundling restrictions, and insurance preauthorization challenges. El-Koussi emphasizes proper use of diagnosis codes, new vs. established patient definitions, and modifiers like 25 and 24 to optimize payment. He highlights the importance of detailed operative notes correlating ICD-10, CPT, and clinical justification to avoid denials. Despite systemic obstacles, meticulous coding, documentation, and engagement with coding committees can help maintain fair reimbursement. Orthopedic reimbursement trends downward; proactive efforts and evidence of value are crucial to sustaining specialty viability.

Asset Caption

Dr. Hussein Elkousy

Keywords

orthopedic reimbursement

sports medicine coding

ICD-10 and CPT

RBRVS payment system

code bundling rules

documentation for reimbursement