Orthopedic Billing Changes Coming in 2016

The New Year is upon us, and we know what that means: change. Orthopedic billing changes will be put into effect January 1st with the new, bundled, and removed codes, along with much bigger changes. During this time, it is important to make yourself aware of these changes on the horizon, become educated on them, and learn how your practice can best adapt to them. By doing so, your business is more likely to better maintain both efficiency and profitability throughout these changes.  

This Year’s Orthopedic Billing Changes  


2015 was introduced with a number of Orthopedic Billing Changes, the official switch to ICD-10 being among them. There were also 264 new codes, 134 revised codes, and 143 deleted codes within the orthopedic coding structure. On top of all this were also a number of changes in orthopedic billing guidelines. The majority of these billing changes effected kyphoplasty, vertebroplasty, image guidance, biopsy, joint injections, and ultrasound guidance. There was also a change in the CPT code modifier 59, of which modifiers XE, XS, XP, and XU were introduced. Now that we’re all caught up on 2015 changes, it’s time to prepare for 2016.

Orthopedic Billing Changes Coming in 2016        

As the routine goes, this upcoming year the Orthopedic billing changes will include more new, bundled, and removed codes. Most of these new codes will be applied to x-rays, E/M prolonged service codes, and paravertebral facet blocks. Perhaps the biggest change we could see in 2016, is reforming the way hip and knee surgeries are paid for. In a proposal presented by the Obama administration, this concept promotes paying healthcare providers for the outcome of the procedure performed, rather than paying for a specific procedure in general. If the proposal is approved for the hip and knee replacements, it could go into effect as early as January 1st, being enforced in medical institutions around the nation. Be sure your orthopedic practice stays up to date and in the loop on the outcome of this legislative decision.

Preparing and Adapting to Change

Being ready for change and adapting quickly to the circumstance is important, especially within the healthcare system. It is crucial in order to minimize rejections, denials, and mistakes to a healthcare billing system to train, educate, and inform your healthcare professionals of new changes. With this, your organization is more likely to reach its goal of keeping the institution’s cash flow steady.

Change isn’t always easy, and we want you to know Healthcare Information Services is here and ready to help. Consider our 65+ trained experts to outsource the management of your Orthopedic Revenue Cycle.  We can take the stress of new information, codes, or regulations, trainings, and education and put it aside as we manage and stabilize your organization’s RCM. Putting your RCM in the hands of HIS will help improve cash flow, maximize reimbursements, increase efficiency and profitability, and keep your practice compliant.

Be ready to grab 2016 by the horns - learn what’s coming, how the changes will affect you, and find a partner to help make your practice the best it can be.