Advanced Orthopedic Specialists
Sports Medicine & Joint Replacement
An orthopedic surgery center achieved 95% coding accuracy and reduced authorization denials by 60%.
The Challenge
Advanced Orthopedic Specialists performs over 2,000 surgical procedures annually, ranging from arthroscopic knee surgery to total joint replacements. Complex surgical coding and prior authorization requirements were creating bottlenecks and revenue leakage.
- Complex surgical coding requiring specialized expertise
- High volume of prior authorization denials
- Inconsistent coding between coders
- Frequent unbundling issues with surgical packages
The Solution
The practice implemented SmartCoding.ai with a focus on surgical coding accuracy. The platform's CCI edit checking caught bundling issues before claims were submitted, and the AI learned the specific patterns of their high-volume procedures.
- Surgical package and unbundling validation
- Modifier 59 and XE/XP/XS/XU recommendations
- Pre-authorization documentation support
- Implant and supply code suggestions
Orthopedic surgical coding is notoriously complex. SmartCoding.ai handles the bundling rules and modifier logic that used to cause us endless headaches. Our denials have plummeted.
The Results
Advanced Orthopedic Specialists saw immediate improvements in both coding accuracy and authorization success rates. The practice eliminated most unbundling-related denials within the first quarter.
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