Coding Guidance for 2009 Ortho Claims

Like most, you’re probably still trying to make heads or tails of all the 2009 CPT® changes. If specialty guidance in orthopaedics is what you seek, Mary LeGrand, RN, CPC, MA-CCS-P, offers it in an article she wrote recently for the American Academy of Orthopaedic Surgeons (AAOS).

A guideline change now identifies fracture codes 27215-27218 as unilateral procedures. For claims to private payers, you can report these codes as such or use modifier 50 Bilateral procedure to report a bilateral procedure. For Medicare, however, use the new G codes (G0412-G0415) to report unilateral or bilateral treatment of fractures.

Orthopaedic Surgery COSC

CPT® Code

Definition

▲27215

Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal fixation, when performed

▲27216

Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or sacrum)

▲27217

Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes public symphysis and/or ipsilateral superior/inferior rami)

▲27218

Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral, include internal fixation, when performed (includes ipsilateral ilium, sacroiliac joint and/or sacrum)

Code

Definition

G0412

Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fractures(s), unilateral or bilateral for pelvic bone fracture patterns which do not disrupt the pelvic ring; includes internal fixation, when performed

G0413

Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, (includes ilium, sacroiliac joint and/or sacrum)

G0414

Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation when performed (includes pubic symphysis and/or superior/inferior rami)

G0415

Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns which disrupt the pelvic ring, unilateral or bilateral, includes internal fixation, when performed (includes ilium, sacroiliac joint and/or sacrum)

Also for 2009, you have two new musculoskeletal CPT® codes: 20696 Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment[s], assessment[s], and computation[s] of adjustment schedule[s] and 20697 Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, removal and replacement) of strut, each. Watch out for definition changes to instrumentation codes (22840-22851) and others due to these code additions. “Add-on codes were deleted because they may not be reported alone and must be reported with the code for the base procedure code,” LeGrand says.

Other guideline changes LeGrand draws our attention to include:

20550 See the new CPT® code(s) 64455 and 64632 for injection of Morton’s neuroma

20930, 20936,

20937 These three bone graft codes may be reported in addition to the new category III codes (0195T and 0196T)

20985 Reinstatement of the Category III codes for 0054T and 0055T and the simultaneous deletion of codes 20986 and 20987. Medicare did not assign relative value units (RVUs) to 20986 and 20987 in 2008 and did not reimburse these procedures. Check with your local Medicare carrier to determine reimbursement because some states consider this a “not medically necessary” procedure.

23585 Revised to reflect the changes in 2009 related to fractures, open reduction/internal fixation (ORIF) and external fixation. CPT® code 23585 now reads Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performed.

27396 (single tendon)

and 27397

(multiple tendons) Revised to reflect any transplant or transfer of muscles, including re-direction or re-routing of muscles to any part of the thigh, and not just the hamstring to patella. You can use these codes to report any transplant of any muscles in the thigh.

28446 Now includes a new reference to use CPT® code 28899 for open osteochondral allograft or repairs using industrial grafts

69990 Revised as inclusive to the new disk arthroplasty codes

72275 Guideline changes related to injection procedures

Report new CPT® codes 64455 Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg, Morton’s neuroma) and 64632 Destruction by neurolytic agent; plantar common digital nerve as bilateral injections, LeGrand advises, but report multiple injections done at the same site only once.

As a final bit of advice, LeGrand says, pay close attention to the cervical disk arthroplasty code additions and revisions. Cervical disk arthroplasty includes many services that cannot be reported separately, such as the operating microscope and fluoroscopic guidance. Codes 22554 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2, add-on code 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure), add-on code 22851 Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure), and 63075 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical single interspace are also included and not separately reportable.

For 2009, LeGrand says, watch out for these new or revised codes as well:

22856 A new code for Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervica

22857 Revised to correct a grammatical change, “single interspace, lumbar”

22861 A new code for Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

22862 Guideline revised to apply only for lumbar revision

22864 A new code for Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

22865 Guideline revised to apply for removal of lumbar disk only

LeGrand’s article “Introducing the 2009 CPT® Code Changes” appears on the AAOS Web site.

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One Response to “Coding Guidance for 2009 Ortho Claims”

  1. Angela says:

    Here some info on ortho coding that we may find helpful.
    Sandra

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