Orthopedic Coding Alert

Remember what you can — and can’t — code with these treatments.

When your orthopedic surgeon treats a patient with cam/pincer lesions, they often have to wade into some complicated surgical territory. Coders will need to know exactly what they should report for these scenarios, as overcoding — and undercoding — are major concerns.

To hit the sweet spot on claims, knowledge of cam/pincer lesion treatments and their corresponding codes is vital. During his Virtual HEALTHCON 2020 session “Deep Dive Into Common Orthopedic Surgeries,” Nate Felt, MS, ATC, PTA, CPC, of Intermountain Medical Group, showed attendees how to code cam/pincer lesion encounters with a detailed case study and some expert advice.

Here’s a look at the case, and how Felt said you should code the claim for maximum ethical reimbursement.

Acetabulum Buildup Marks Cam/Pincer Lesions

Cam/pincer lesions occur when there is an overgrowth of acetabulum that needs removing, Felt explained. These two conditions are often referred to as femoroacetabular impingement (FAI).

A pincer lesion is an “overgrowth of acetabulum when the cup is digging in and ‘penny pinching’; hitting on the neck of the femur. When that happens your body builds up bone growth there,” Felt explained. And as a patient suffering from this condition, “you’re going to have some problems, you’re going to have some pinching, you’re going to have some catching,” he said.

A cam lesion is a bump on the edge of the femoral head. When your provider treats either of these conditions, you’ll use the cam/pincer lesion treatment codes.

“These are newer codes and orthopedic surgeons are doing them a lot more frequently,” said Felt. “And they’re doing them really well; now patient can come in with this disorder, and they can come out with not very much rehab needed and they can return to sports, or just active lifestyle, pretty quickly.”

Watch Bundles When Selecting Codes

During a cam/pincer lesion treatment, your surgeon might provide treatments represented by these codes:

• 29862 (Arthroscopy, hip, surgical; with debridement/ shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum)
• 29863 (… with synovectomy)
• 29914 (… with femoroplasty (ie, treatment of cam lesion))
• 29915 (… with acetabuloplasty (ie, treatment of pincer lesion))
• 29916 (… with labral repair labral repair)

While these codes have been around awhile, they do represent relatively recent medical advances, Felt said. Before you could treat cam/pincer lesions arthroscopically, physicians had to make a surgical opening to treat the lesions. So you need to be sure to code as carefully as possible, as payers’ eyes often linger on claims for relatively recent techniques and procedures.

Pay attention to exceptions: As you might expect, 29914 and 29915 will feature most heavily in cam/pincer lesion treatments. There are certain code combinations from this list that you’ll want to avoid, Felt warned.

Quoting directly from the CPT® manual, Felt gave coders the following reminders:

• “Don’t report 29914, 29915 in conjunction with 29862, 29863.”
• “Don’t report 29916 in conjunction with 29915, 29862, 29863.”

With these exceptions in mind, we’ll proceed to the case study.

The Case

Check out the encounter notes for the case, followed by coding and an explanation:

• DESCRIPTION OF PROCEDURE: Timeout was performed in the preop area after marking the affected hip and knee, patient brought back to OR, placed on Hana table and given general anesthesia.
• Patient placed in boot traction/tourniquet and extremities well-padded. Final timeout performed. L hip/knee surgical areas prepped/draped.

Starting with hip: Surgeon makes anterolateral, mid-anterior accessory, and distal anterolateral accessory portals. Scope inserted to confirm position of portals on fluoroscopy. Shaver used to remove fat and expose capsule. Capsulotomy in line with intertrochanteric line up to the rim 1cm distal to attachment of reflected head of rectus. This was started on the head/neck junction and performed distal and then proximal. Traction placed and shaver used to remove Synovitis/enter joint.

Central component inspected under traction; marked thinning/ attenuation of t acetabular labrum from 9:00 to 1:00. Rim of acetabulum exposed, proceeded with acetabuloplasty using motorized shaver. 4mm of acetabular rim removed between 9:00 and 1:00. Adjacent articular cartilage appeared healthy.

Surgeon then attended to femoral side. Head/neck junction clearly identified, along with deep pincer groove. Performed femoroplasty beginning at articular cartilage proximally and terminating at neck base, which created a gentle concave contour. Contour verified with image intensifier.

Surgeon satisfied with surgical status both on fluoroscopy and arthroscopy. Capsule closed with: 3 Ultrabond stitches through capsule; 3-0 Monocryl used in skin; Steri-Strips, local, and sterile dressings over top of surgical area.

Potential Codes

During this encounter, the surgeon performed three procedures:

• Debridement of diminished labrum (29862).
• Acetabuloplasty of acetabular rim (29915).
• Femoroplasty from articular cartilage to base of neck (29914).

Not so fast: Before you file this code trio, you need to check out the CPT® exceptions, which forbid you from reporting 29862 with 29914 or 29915.

Final Verdict

For this encounter, you should only report 29914 and 29915. If the payer requires it, you would append modifier 51 (Multiple Procedures) to 29914.