Specialty-Specific Coding Myths & Mistakes: Orthopedics, Anesthesia, Cardiology, Mental Health

Accurate medical coding is essential for healthcare providers to receive timely reimbursement, ensure compliance with payer requirements, and avoid audit risks. However, coding is not a one-size-fits-all discipline—especially when it comes to specialized fields like orthopedics, anesthesia, cardiology, and mental health. Each specialty has its own rules, nuances, and frequent coding traps.

In this blog, we break down the most common coding myths and mistakes by specialty, shedding light on how providers and billing teams can avoid denials, overpayments, or worse—allegations of fraud.

Orthopedics: Myths and Mistakes in Musculoskeletal Coding

Orthopedic practices deal with complex procedures involving joints, bones, ligaments, and tendons—making accurate coding particularly challenging.

Myths

Myth #1: You can code based on radiology findings alone.
Wrong. ICD-10 coding for orthopedic diagnoses must reflect the provider’s clinical assessment. Radiology findings are not standalone evidence of a diagnosis.

Myth #2: A post-operative visit is always billable.
Many providers mistakenly bill follow-up visits that fall within the global surgical period. These visits are generally bundled into the global fee and not separately reimbursable, unless there is documentation of unrelated services or complications.

Common Mistakes

  • Wrong laterality coding (left vs. right) leading to claim denials.
  • Using unspecified fracture codes instead of specific terms like “displaced” or “nondisplaced.”
  • Failing to link injection codes (e.g., 20610) with the appropriate diagnosis and joint site.

Tip: Use detailed operative reports and ensure the correct use of modifier 59 or X modifiers when procedures are done on separate anatomical sites.

Anesthesia: Myths and Mistakes in Time-Based Billing

Anesthesia billing is unique due to its dependence on base units, time units, and modifiers. Yet, this complexity breeds misinformation.

Myths

Myth #1: Documenting only start and stop time is sufficient.
Not quite. While start and stop time is critical, documentation should also include pre-op evaluation, intraoperative monitoring, and post-op care, if applicable, to justify the full scope of anesthesia services.

Myth #2: CRNAs and anesthesiologists can always bill separately.
In Medicare cases, if both are involved in the same procedure, only one provider can bill under certain conditions (e.g., medical direction). Otherwise, billing both can lead to double-billing red flags.

Common Mistakes

  • Incorrect time calculation—rounding up time units or failing to subtract breaks.
  • Not appending modifiers like AA, QX, QZ, QK, etc., which designate the provider type and billing context.
  • Billing for Monitored Anesthesia Care (MAC) without proper documentation supporting its necessity.

Tip: Work closely with coders experienced in ASA Relative Value Guide (RVG) and ensure accurate capture of anesthesia time to the minute.

Cardiology: Myths and Mistakes in High-Stakes Coding

Cardiology billing includes complex diagnostic tests, interventional procedures, and chronic condition management—each with strict rules.

Myths

Myth #1: You can bill for EKG interpretation with just a signature.
False. CMS requires a written interpretation and report, not just a review or signature, to bill CPT 93010.

Myth #2: Global periods don’t apply to interventional cardiology.
They do. Procedures like stents or catheterizations have global periods during which routine follow-ups are not separately billable.

Common Mistakes

  • Overlapping or unbundling procedures (e.g., billing separately for cath components already bundled).
  • Using unspecified diagnoses like I51.9 (Heart disease, unspecified) instead of more precise ICD-10 codes.
  • Billing prolonged services (99354–99357) without meeting required time thresholds or documentation.

Tip: Know the National Correct Coding Initiative (NCCI) edits and use modifier 25 carefully when billing E/M with diagnostic testing.

Mental Health: Myths and Mistakes in Behavioral Health Coding

Mental health providers are increasingly involved in outpatient settings, telehealth, and integrated care, but coding remains a challenge—especially for psychotherapy, testing, and time-based services.

Myths

Myth #1: Time doesn’t matter for therapy sessions.
Wrong. CPT codes for psychotherapy (e.g., 90832, 90834, 90837) are time-specific, and documentation must clearly reflect the session duration.

Myth #2: Telehealth therapy can always be billed using standard codes.
Not always. Payers may require POS 02, modifier 95 or GT, or even different codes for audio-only sessions vs. full video telehealth.

Common Mistakes

  • Billing for evaluation and psychotherapy together without proper documentation supporting both.
  • Incorrect use of add-on codes like 90833 (psychotherapy with E/M) without a primary E/M code.
  • Billing psych testing codes (96130–96133) without clear documentation of time spent interpreting and scoring tests.

Tip: Stay up to date with evolving payer policies, especially around telebehavioral health and audio-only allowances.

The Hidden Risk: Payer-Specific Variations

Beyond the myths and standard coding issues, a common pitfall in all specialties is assuming uniform rules across payers. Medicare may follow CMS guidelines, but private insurers may require different:

  • Modifiers
  • Documentation formats
  • Prior authorizations
  • Global period lengths

A mistake that passes one payer’s system might result in denial or post-payment review from another.

Conclusion

Coding mistakes aren’t just administrative nuisances—they affect reimbursement, patient billing, audit exposure, and even your reputation. The challenge is amplified in specialty practices, where nuanced guidelines, complex procedures, and frequent payer updates create fertile ground for errors and misconceptions.

Key Takeaways:

  • Don’t rely on assumptions—coding rules vary greatly by specialty and change frequently.
  • Make sure documentation supports every code, especially in time-based services like anesthesia and mental health.
  • Use modifiers correctly, especially when procedures are bundled or performed in conjunction.
  • Avoid unspecified codes unless absolutely necessary—specificity improves claim approval rates.
  • Train your staff on specialty-specific billing practices and conduct regular coding audits.

The smartest investment a practice can make in 2025 is in education and technology that ensures coding is both accurate and defensible.

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