Orthopedic Coding Alert

" CPT and the AMA may have just made the orthopedic coder's life a little easier. CPT 2002 includes 89 changes to codes in the musculoskeletal system chapter, 31 of which are new codes. Eight of these new codes deal with arthroscopic surgery and will in many cases eliminate the need for submitting unlisted-procedure codes for surgeries that up until now had no CPT code.
 
The 2002 changes go into effect Jan. 1, 2002. Practices should plan changes to super bills, encounter forms, charge tickets, etc., but hold off on implementation until after Jan. 1.
 
According to Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., many carriers do not update their fee schedules until February or March, so poll your major payers to determine when they will activate new CPT codes. Jumping the gun can result in a rash of denied claims" " Stout says.
   
Note: New codes appear here in bold type and revised codes are in plain type. As in past issues all new revised and deleted codes are listed in Appendix B of CPT 2002.
Dotting I's and Crossing T's
Many of the changes to existing codes involve the slightest grammatical or even punctuation changes but even those slight revisions can change the nature of the code. For instance 20225 now reads: biopsy bone trocar or needle; deep (e.g. vertebral body femur). The only change in the code definition is the addition of "e.g." But the change means that a deep bone biopsy includes but is not limited to the vertebral body or the femur.
 
The most minor changes appear in the 21182-21184 code group (reconstruction of orbital walls rims forehead nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone [e.g. fibrous dysplasia] with multiple autografts [includes obtaining grafts]; total area of bone grafting ). The choice of code depends on the size of area of bone grafting e.g. 40 square centimeters. That measurement used to be shown as 40cm but the term for the measurement is now 40 sq. cm.
New and Revised Injection Codes
The 20000 series of injection codes includes a number of new entries. These new codes offer options for reporting injection of the carpal canal for carpal tunnel syndrome as well as a range of codes for reporting those troublesome trigger-point injections. Expansion of this section of codes will allow for more accurate reporting and less confusion about location purpose and number of injections rendered.
  20526 injection therapeutic (e.g. local  anesthetic corticosteroid) carpal tunnel.