Orthopedic Coding Alert

In September 2001 the AMA introduced a series of temporary Category III, or emerging-technology, CPT codes for reporting clinical trials and newer surgical technologies. The codes will help the AMA determine the frequency with which clinical trials and procedures are being conducted as the trials move toward approval (if deemed successful).
 
For orthopedic practitioners and coders who are attempting to bill for these procedures, the codes do two things: 1. They provide an external and internal means of reporting the procedure(s), and 2. They may lead to reimbursement. As the initial AMA memo on the topic states, Payment for these services/procedures is based on the policies of payers, so payment for these codes is entirely up to payer discretion. The codes have no relative value units (RVUs) assigned. If a practice arranges with a carrier for the code(s) to be paid, it will also need to negotiate the rate of reimbursement. 
 
Three codes in the series are of particular note to orthopedists:

0012T arthroscopy, knee, surgical, implantation of osteochondral graft(s) for treatment of  etc.; autografts

0013T ... allografts

0014T meniscal transplantation, medial or lateral, knee (any method).

 
According to Billie Jo McCrary, CPC, CCS-P, CMPC, practice manager of Wellington Orthopedic and Sports Medicine, a six-office practice with 18 physicians in Cincinnati, the Category III codes do not so much represent new procedures as they do the AMAs recognition of them. Surgeons in her practice have been performing the above procedures for some time, and billing carriers with the code for unlisted arthroscopy (29909) or unlisted knee procedures (27599).
 
It is important that CPT 2002 instructs practices that perform the above procedures to report the Category III code in lieu of the Category I unlisted-procedure code. The new codes are also noteworthy because the AMA is strongly considering approving them. The AMA memo reads that Category III codes will allow data collection for these services/procedures. 
 
Tammy Harwell, billing coordinator for Orthopedic Associates LLP, in Reno, Nev., says the codes will help the AMA determine how often orthopedists conduct these procedures and use that data to evaluate the need for creating a Category I code. These procedures are becoming increasingly commonplace, says Harwell, who adds that her physicians have been conducting osteochondral grafts on younger patients and, until now, using the code for microfracture procedure 29879 (arthroscopy, knee, surgical; abrasion arthroplasty [includes chondroplasty where necessary] or multiple drilling or microfracture) with an unlisted-procedure code.
 
The osteochondral graft is especially common with younger patients, Harwell says, because it can postpone or prevent the need for a total knee arthroplasty, which is good news for younger, more active patients.
 
The most recent AMA memo on Category III codes can be found in CPT 2002, Category III codes immediately following the Category I code section.