Advanced Specialty Orthopedic Coding Tips–Spinal Fusions and Joint Replacements Webinar

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Highlights of this episode include:

• What the webinar is covering
• Why it is an important topic to cover
• What is a spinal fusion
• Pitfalls in spinal fusion coding
• Documentation’s role in coding accuracy
• What difficulties coders typically face when coding these procedures
• Joint replacement coding
• Actionable tips

Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast.  We’re pleased to welcome back Kristen Eglintine, BESLER’s senior manager of revenue integrity services of coding and projects. In this episode, Kristen will provide us with a glimpse into BESLER’s next free Webinar, Advanced Specialty Orthopedic Coding Tips: Spinal Fusions & Joint Replacements, that we’re hosting live on Wednesday, February 4, at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristen.

Kristen Eglintine: Hi, Kelly. Well, and thank you for having me back. I’ve got some good information to share today, so I’m excited to be here.

Kelly: Awesome. Let’s go ahead and jump in then. So BESLER’s upcoming webinar, Advanced Specialty Orthopedic Coding Tips: Spinal Fusions & Joint Replacements, offers an in-depth look at ICD-10 PCS Coding for these complex procedures. Why is this an important topic to cover?

Kristen: So great question. Way to start it off. So orthopedic coding is a top priority for BESLER this year as it was actually driven by listener feedback. Coders and CDI specialists from our recent past webinars asked for more focused orthopedic procedure training. And that’s always something we look to prioritize. Why the strong interest in orthopedics, though? I’d say one of the reasons orthopedics is so engaging is that it really checks all the boxes. Complex anatomy. It has big financial impacts and outcomes that you can clearly see in the patients’ lives. So, when you’re working and coding cases like joint replacements or spinal fusions, it just doesn’t feel routine. It can feel significant and rewarding. There’s also clinical and human impacts. Orthopedic cases often restore mobility and independence. So, coders feel more closely connected to meaningful patient outcomes, whether that just be someone being able to walk again or just experiencing some pain relief. There’s also an intellectual challenge as orthopedics requires strong understanding of detailed anatomy. Orthopedic cases have a financial and compliance impact. Procedures are high-cost, high-volume, and heavily scrutinized, so accurate coding has a big impact on revenue integrity. So, when you put all of that together, it’s a topic that’s well worth exploring in more depth.

Kelly: Yeah. I mean, it sounds intriguing. You know Let’s dive right in with spinal fusions. What exactly is a spinal fusion? And why might a patient need one?

Kristen: Spinal fusion is a surgery that permanently joins two or more vertebrae so that they heal into a single solid bone and no longer move independently. The most common conditions treated with spinal fusions are those that would cause instability, deformities, or ongoing nerve compression, especially when conservative treatments just haven’t worked. In many cases, patients have already tried options like PT, they’ve tried medication or injections without lasting relief. These situations often stem from degenerative changes in the spine. They can stem from traumatic injuries or underlying structural abnormalities. And then over time, these issues lead to pain, loss of function, or neurological symptoms that significantly impact a patient’s quality of life. So, when that happens, a spinal fusion becomes a way to stabilize the spine. It reduces abnormal movement and relieves pressure on the nerves. Coding a spinal fusion is tricky. The code set expects precise detail on anatomy, levels, approach, techniques, and devices. And all of that has to be pulled correctly from the operative note. So then even small misreads can lead to the wrong code, the wrong number of levels, or just missed add-on codes.

Kelly: Can you expand on that last thought? What does a coder need to pay special attention to in an operative note to code a spinal fusion correctly?

Kristen: So great question. Spinal anatomy is complicated, and that’s where a lot of the coding challenges come in. Coders have to clearly understand the difference between vertebral segments versus inner spaces. They have to know how to correctly count levels and recognize when a fusion crosses regions like cervical into thoracic or lumbar. On top of that, there are multiple surgical approaches and techniques. A surgeon might use an anterior, posterior, lateral, or even a combined approach in the same case. And each of those maps to different codes. Depending on which vertebrae are being fused, the patient’s position could vary. Sometimes they’re prone while the surgeon accesses the spine from the back, and other times they’re supine, and the surgeon is working through the neck. Coders also need to pay attention to the devices used, whether that’s cages, interbody fusion devices, or instrumentation versus simple fixation hardware, and make sure the bone graft types and sources are captured accurately.

Kelly: Very interesting. It sounds very intricate and complex. Could you highlight the most common pitfalls in spinal fusion coding?

Kristen: Yeah, there definitely are some. A few coding challenges that we will really try to address in the webinar are– the first one I’d say is around device selection. Expanding on what I just mentioned, coders sometimes confuse the internal fixation hardware, like plates and screws with the true fusion device, such as the interbody fusion device, a cage, or the bone graft itself. That distinction matters in ICD-10-PCS, and it’s not always obvious in the operative note. Another big pitfall has to do with coexisting procedures performed during a spinal fusion. So, fusions are often done alongside a laminectomy or a diskectomy or an osteotomy or deformity corrections. And coders have to know which of these services are considered part of the fusion and which ones can be reported separately. And again, this is not always a clear line. One reason it’s so challenging is that multiple procedures often happen in the same anatomical region. When several spine procedures take place at the same operative site, coders have to carefully interpret the operative note to understand exactly what was done, why it was done, and whether it meets the definition of a separate PCS route operation. Another challenge is that some procedures are actually inherent to the fusion itself. So, for example, let’s look at decompressive work.

So that may simply be part of the surgical exposure needed to complete the fusion, or in other cases, that decompression is a separate, clinically necessary service. And knowing the difference requires close reading and a solid understanding of PCS definitions. And then there’s the surgical approach. So, the approach used to reach the vertebrae, again, so whether that’s anterior or posterior or lateral or combined, it can be tricky to identify and does have a direct impact on the code selection. That means coders really have to slow down and carefully read the operative note to make sure they’re interpreting it correctly.

Kelly: Wow, thank you for sharing those pitfalls with us. We emphasize documentation’s role in coding accuracy in many of our webinars. Would you say that’s especially true for spinal fusions as well?

Kristen: Absolutely. Documentation variability is another big challenge. Surgeons don’t all describe levels, approaches, and devices the same way. So, coders have to translate that narrative language the surgeon would use into very specific code terms. And when those details aren’t clearly there or documented, clarification becomes critical, such as a query. Otherwise, you’re risking denials, audits, or just inaccurate data.

Kelly: So let’s go ahead and turn into joint replacements. What difficulties do coders typically face when coding these procedures?

Kristen: So joint replacement coding can be tricky, just as spinal fusions, because there are so many code options, a lot of documentation detail to capture, and even small mistakes here can have a big financial impact too. Hip and knee arthroplasties in particular come with dozens of possible ICD-10 PCS codes and related billing combinations. So, translating the operative no into the most accurate set of codes isn’t always straightforward. Let me give you a few examples of the level of detail coders really have to capture when it comes to joint replacements, because this is where it can get tricky.

So, first, there’s the anatomic and procedural detail. Coders need to know the exact side, so right or left. They need to know the specific joint involved. So, it could be hip, it could be a knee, sometimes even a shoulder. And whether the procedure was partial or total or a revision, every one of those details changes the code. Revision surgeries add another layer of complexity. That documentation has to be clearly spelled out, including which components were removed, which were left in place, and which were replaced. So, things like the femoral or tibial component, the liner, or the patella, different combinations of those actions can point to entirely different codes. And then on top of that, there’s a lot of code choices that sound very similar.

So, in ICD-10 PCS, a joint replacement can translate into hundreds of possible options based on body part, approach, device, and material. That really increases the risk of inconsistency or miscoding if the documentation isn’t crystal clear. For revisions in particular, coders are often deciding between codes that seem almost interchangeable, like removal, replacement, or revision of a synthetic substitute. But, really, each represents a distinct root operation. Understanding those subtle differences is critical because it directly affects the PCS code and how the procedure is ultimately reported.

Kelly: Wow, so it seems joint replacement coding is every bit as challenging as spinal fusion coding. Can you tell us a little bit more?

Kristen: Oh, yes, it definitely is every bit as challenging. When it comes to total hip and knee replacements, the documentation really matters. Coders need clear details on laterality and the joint involved. Again, right versus left, hip versus knee, and then whether it’s total or partial they also need to know the type of material of the prosthetic. So, whether it’s cemented or uncemented, they need to know whether it’s metal or ceramic and whether it is an initial replacement or a subsequent procedure. Another big distinction is whether the surgery is a true replacement or a revision in ICD-10 PCS. So, a revision usually means adjusting or correcting part of an existing prosthesis, like swapping out a liner or repositioning a component. A replacement, on the other hand, involves removing the old prosthesis and putting a new one in. And that distinction drives the root operation and ultimately, again, affects what code we report.

Kelly: Thank you for explaining that for us a little bit more. So, if listeners want to walk away with just one actionable tip from our conversation today, what should it be?

Kristen: If there’s one takeaway from today’s discussion, it’s this. Solid, precise documentation is the foundation of accurate and compliant orthopedic coding. Whether you’re coding a spinal fusion or a joint replacement, the level of detail in the operative note. So, anatomy, approach, devices, levels, and intent directly determines coding accuracy. It directly determines reimbursement integrity and your audit risk. Clear documentation empowers coders to choose the correct route operations, capture all clinically significant procedures, and avoid denials or data errors. And that’s exactly why training, like our upcoming webinar, is so valuable. So, I highly recommend please take an hour. Join us Wednesday, February 4, 1 PM Eastern Standard Time. I promise you won’t regret it. Thanks again for listening and being part of our audience today.

Kelly: Thank you so much for joining us, Kristen, and for giving us this sneak peek into BESLER’s upcoming webinar, Advanced Specialty Orthopedic Coding Tips: Spinal Fusions & Joint Replacements, that you’re presenting live on Wednesday, February 4, at 1 PM Eastern time. And as a bonus, you can earn CEU. Thanks again, Kristen.

Kristen: Thank you. Have a great day, everybody.

Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…

If you have a topic that you’d like us to discuss on The Hospital Finance Podcast or if you’d like to be a guest, drop us a line at update@besler.com.

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