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44 PRACTICE MANAGEMENT The Tricky Nature of ICD-10 Coding for Spinal Fusions — 6 Things to Know By Megan Wood C oding spinal fusion procedures for ICD-10 involves many complexities, according to ICD 10 monitor. Ensure you are reviewing operative reports appro- priately to boost accuracy and efficiency as well as reduce errors. Here are six things to know: 1. To correctly assign a code for a spinal fusion, knowledge of spinal anatomy and physiology will be helpful. First, denote the proper qualifier: • Anterior approach, anterior column • Posterior approach, posterior column • Posterior approach, anterior column 2. Identifying the approach can be difficult, because the approach doesn't necessarily cor- relate with the column on which the surgeon performed. It's important to note that no code exists for the anterior approach alone, but rather there will be two reports involved. 3. Aer a coder has identified the approach, the next step involves pinpointing the part of the spine undergoing fusion. Determining this may also prove challenging as spinal fu- sions oen include various devices. For exam- ple, the use of an interbody fusion device will indicate fusing of the anterior column. Refer to ICD-10-PCS Guideline B3.10c for help in identifying the device value for fusion proce- dures if multiple devices are used. 4. A 360-degree fusion will oen trip up cod- ers, because it involves both the anterior and posterior. As a coder, ensure you closely read the operative report's body and header, tak- ing in every word. A common mistake here involves coding only for the anterior fusion and leaving out the posterior fusion. 5. Poor coding will negatively impact data accu- racy and reimbursement. erefore, extra train- ing in spinal fusion coding will go a long way. Make sure the coders understand spinal anato- my and keep them up to date with new devices. 6. It may also prove helpful to designate a specialty coder who understands the ins- and-outs of spinal fusions. n 11 Highest-Paying States for Orthopedic Surgeons: New Jersey Tops the List at $494.5k By Mary Rechtoris T he average salary for an orthopedic surgeon totals $426,590. However, this figure may vary based on where orthopedic surgeons practice throughout the United States, according to Insider Monkey. Here are the 11 highest paying states for orthopedic surgeons: 1. New Jersey: $494,510 2. Washington, D.C.: $487,773 3. California: $484,118 4. New York: $475,933 5. Connecticut: $469,966 6. Massachusetts: $463,856 7. Alaska: $460,991 8. Maryland: $456,717 9. Rhode Island: $450,404 10. Washington: $450,100 11. Delaware: $449,467 n 25% of Reimbursement Tied to Alternative Models in 2016 By Brooke Murphy A bout one in four payments for healthcare services in private and public markets were tied to alternative payment models in 2016, according to a report from the Health Care Payment Learning & Action Network. In March, HHS declared that an estimated 30 percent of Medi- care fee-for-service payments were tied to alternative payment models. LAN's study attempts to estimate the adoption rate of alternative payment models nationally across commercial, Medicare Advantage and state Medicaid market segments. To quantify the adoption of alternative payment models na- tionwide, LAN collected contract data from 40 health plans representing more than 128 million covered lives, or nearly 44 percent of the combined commercial, Medicare Advantage and Medicaid markets. The study also assessed healthcare spending as of January 2016 across the aforementioned three markets. Here are four quick findings. • The study found about 25 percent of healthcare dollars were tied to alternative payment models in 2016, up from 23 percent in 2015. • About 22 percent of commercial healthcare dollars were tied to alternative payment models in 2016. • About 41 percent of Medicare Advantage healthcare dollars were tied to alternative payment models in 2016. • About 18 percent of Medicaid dollars were tied to alter- native payment models in 2016. n