Redefine Code Relationships for Orthopaedic Surgery in 2012
CPT® introduces new arthroscopy codes, and changes usage guidelines for those frequently used.
By Denis Rodriguez, CPC, CCS
Changes in CPT® 2012 for orthopaedic surgery coding redefine the relationships between frequently reported arthroscopy codes and bring two new codes for treatment of Dupuytren’s contracture.
Code +29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for the primary procedure) has become an add-on code for 2012.
The procedure involves “exposing the subacromial space, bursectomy, debridement, detaching the coracoacromial ligament and removing the undersurface of the acromion,” according to the May 2001 CPT® Assistant. The article also states, “The partial acromioplasty, arch decompression, excision of bursal tissue and release of the coracoacromial ligament would not be reported separately, as these are considered to be inclusive components of code 29826.” This does not appear to have changed.
As an add-on, 29826 must now be reported with a primary surgical shoulder arthroscopy (29806-29825, 29827, or 29828). The American Medical Association (AMA) says that arthroscopic subacromial decompression/acromioplasty is performed with other arthroscopic shoulder procedures 95 percent of the time, and has not yet provided guidance for coding arthroscopic subacromial decompression/acromioplasty as the sole arthroscopic shoulder procedure performed during a surgical session.
Another arthroscopic code “relationship change” is the inclusion of 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) in codes 29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed and 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed.
According to the new descriptors for 29880 and 29881, it does not matter whether the chondroplasties are performed in the same compartment as the meniscectomies; meniscectomy will now include any chondroplasty performed in the knee.
For example, if a surgeon performs an arthroscopic chondroplasty of the patella along with arthroscopic medial meniscectomy, only 29881 would be reported in 2012. In 2011, for payers that bundle according to AMA/CPT® guidelines and not National Correct Coding Initiative (NCCI) edits, both 29881 and 29877-59 Distinct procedural service had to be reported because the two procedures were performed in separate compartments.
When arthroscopic chondroplasty is performed in the absence of meniscectomy, you may still report 29877 (provided it does not bundle with any other code).
New Choices for Dupuytren’s Contracture
There are two new codes for the treatment of Dupuytren’s contracture by injection of enzyme, followed by manipulation of the palmar fascial cord at a subsequent encounter. This is a thickening and contracting of the palmar fascia, which restricts movement of the fingers. The condition often presents as nodules in the palm and can progress to a cord-like thickening extending to the fingers.
Code 20527 Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren’s contracture) has been established for the initial injection procedure. HCPCS Level II code J0775 Injection, collagenase, clostridium histolyticum, 0.01 mg may be reported in addition when the billing provider supplies the Xiaflex® (collagenase).
The subsequent manipulation procedure is coded to 26341 Manipulation, palmar fascial cord (ie, Dupuytren’s cord), post enzyme injection (eg, collagenase), single cord.
Code descriptors’ language implies that these codes are reported once per palmar fascial cord treated. A parenthetical note instructs you not to report separately fabrication/application of any custom orthosis. To report 26341, 20527 must have been performed on the same hand on a prior date of service.
During a typical treatment, the physician would inject Xiaflex® into the thickened, contracted fascial cord in three separate locations. Needle placement may be confirmed by assessing neural function and tendon flexion. This would be reported with CPT® code 20527 and HCPCS Level II code J0775.
The next day, the patient returns. The wrist is held in flexion while traction is placed across the injected cord until the cord is felt to rupture and the involved digit is fully extended. The traction may be repeated several times until cord rupture is confirmed. This portion of the procedure would be reported with 26341.
Denis Rodriguez, CPC, CCS, is senior ambulatory surgery center (ASC) coder and compliance auditor for The Coding Network, LLC. He has more than 20 years experience in the medical field, the last nine of which have been spent exclusively in ASC coding, auditing, and education.