Fig. 1 Code-X’s mobile version, “Code-X Lite,” includes most of the features from the desktop version, including access to the AAOS Global Service Data guidelines.


Published 6/1/2019
Cheryl Toth, MBA

Tips and Best Practices for Using Code-X

Editor’s note: This concludes a two-part series on Code-X. Part one appeared in the May issue of AAOS Now.

After speaking with Michael Marks, MD, MBA, and Margaret Maley, BSN, senior consultants from KarenZupko & Associates, Inc., (KZA) about the most valuable features of Code-X in part one, Cheryl Toth, MBA, spoke with Madelaine Reese, senior product manager of online learning at AAOS, about tips for getting the most out of this coding and compliance tool, which was developed by AAOS.

Ms. Toth: The name Code-X could lead some to believe it’s just a coding reference tool. From your perspective, what makes it different?

Ms. Reese: You’re right—Code-X includes Current Procedural Terminology; International Statistical Classification of Diseases, 10th Revision (ICD-10); and Healthcare Common Procedure Coding System codes. But it goes way beyond just a coding reference. It drills down into the orthopaedic codes and provides cross-references (i.e., Code -X”) to relative value units (RVUs), National Correct Coding Initiative (NCCI) edits, and Medicare’s geographic practice cost index data. It also includes AAOS’ Global Service Data guidelines, which are not available on any other coding platform. All of these functions help practices code with compliance and collect the payments they are owed. No matter which tab you click from within the Code-X software, everything is displayed on one screen. In a matter of seconds, staff have the correct information to avoid denials and potential audits.

Ms. Toth: Who is the intended user for Code-X—the physician or office staff?

Ms. Reese: It’s a blend, but it begins with the surgeons. Best practice—the surgeon looks up and chooses the right codes in the mobile app, which most physicians find easier to use, especially from the hospital or surgery center. The billing staff then use Code-X to make sure that the codes the doctor selected are correct according to the Global Service Data guidelines and NCCI edits and add modifiers. When payment comes in, the staff verifies its accuracy using the Code-X RVU calculator and stores this information for each code and plan, using the payer management feature.

Ms. Toth: I didn’t realize that Code-X had a mobile version.

Ms. Reese: Yes, and we have really built up the mobile app for easier use. It has most of the same features as the desktop version, and we recently added access to the Global Service Data guidelines (Fig. 1). The mobile app is called “AAOS Code-X Lite” and is available for iOS and Android download.

Ms. Toth: Does Code-X tell users which codes can or should not be billed together?

Ms. Reese: Code-X includes the Academy’s Global Service Data guidelines, which provide this information. Just put the code(s) into the tool, and you get information about what is and is not included in a bulleted format. Think about how much time this could save the staff who would otherwise be searching multiple websites or other sources. The information is both accurate and credible.

Ms. Toth: Can you explain the ICD-10 look-up feature? I have heard surgeons really like this feature.

Fig. 1 Code-X’s mobile version, “Code-X Lite,” includes most of the features from the desktop version, including access to the AAOS Global Service Data guidelines.
Fig. 3 Managing a list of “Favorites” saves surgeons time when coding frequently performed procedures. The list can be exported and shared with colleagues.

Ms. Reese: They do. We knew how difficult the switch would be to ICD-10, so we created drop-down menus that make finding the right code easier. You don’t have to enter the whole word or code. For example, you can choose “ACL, left” from the menu, and it populates the possible codes. With one click, you select the correct one. A lot of thought went into that.

Another trick is the color coding that indicates whether a diagnosis code is acceptable or has been deleted (Fig. 2). If you choose a code with a green checkmark, it means the code is acceptable. If it’s red, the code has been deleted, so you cannot use it. We update Code-X every quarter, so users can be sure the color coding is accurate.

Fig. 2 Color coding, such as these green check marks, makes it easy to understand the correct codes to use.

Ms. Toth: Are there any features you hear physicians rave about?

Ms. Reese: People really like the “Favorites” feature—a custom list of frequently used codes that surgeons can build, share, and curate to help quickly pick a code (Fig. 3). This list syncs between desktop and mobile. The list can also be exported from Code-X and shared with colleagues, so they don’t have to recreate the list. Simply click Export to CSV, email the file, and ask the user to click Import from CSV. This same process is followed when upgrading Code-X from last year’s version to the current version.

Ms. Toth: I recall Dr. Marks saying he uses the RVU calculator regularly.

Ms. Reese: People tell me they like the RVU calculator a lot. The fields can be adjusted depending on whether you bill by facility or nonfacility. You can change the percentage. The calculator defaults to Medicare rates, but if you want to calculate whether the payment is correct for a Blue Cross Blue Shield plan, for example, users can change to the percentage of Medicare that the plan pays. It’s a great way to build out the payment schedule for each payer when it’s not initially provided.

Ms. Toth: Are there any Code-X features that you think could be used more frequently?

Ms. Reese: I would say the E/M Analyzer. It’s a powerful compliance tool that many surgeons and staff overlook because it’s not something they use daily. The E/M Analyzer helps users understand whether the evaluation and management (E/M) coding patterns follow those similar to other orthopaedic surgeons in the state and nationally, based on available data from the Centers for Medicare & Medicaid Services. Enter each physician’s E/M code usage, and the E/M Analyzer creates a line graph to show how the physician’s pattern compares to others.

Ms. Toth: Are there any other “tricks” you want to share?

Ms. Reese: I find that many surgeons don’t realize they can email codes from within the mobile app. There’s no need to wait until you are back in the office. Code-X allows physicians to send the codes to staff right from the operating room, so they can bill the case.

AAOS partners with KZA on the organization’s coding education. For more information, visit

Cheryl Toth, MBA, is director of content development for KZA. This article was written on behalf of the Academy and its coding committee. KZA is an official Academy partner on related education.