Orthopedic Coding Alert

This deletion could add $69 to your practice's bottom line--but make sure you adhere to this criteria.

If claims involving fluoroscopy, anesthesia, and disc procedures often land on your desk, then you should pay attention to the more than 200 orthopedic edits included in the Correct Coding Initiative (CCI) version 16.1, which went into effect April 1.

That's a fairly big chunk of the "2,054 new edit pairs, with 1,947 modifier indicator changes" you'll find in CCI 16.1, says Frank Cohen, MBB, MPA, of MIT Solutions, Inc., in Clearwater, Fla.

Don't be caught with a denial because you've overlooked these changes. Here's the lowdown, broken into deleted edits, new non-mutually exclusive edits, and mutually exclusive edits.

Deleted Edits Give New Coding Opps

Good news: A few deleted edits in CCI 16.1 could mean reimbursement for additional services.

Until now, using fluoroscopic guidance during hip and knee arthrography was considered standard practice. New edits allow you to report 77002 (Fluoroscopic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device]) in addition to three procedures:

27093 -- Injection procedure for hip arthrography; without anesthesia

27095 -- ... with anesthesia

27370 -- Injection procedure for knee arthroscopy.

Pay boost: Being able to code 77002 in addition to the injection could bring $69.64 (or 1.93 total RVU, based on the current national conversion factor of 38.0846) to your bottom line if your physician owns the equipment, based on the national average Medicare fee. Reporting only the professional component (which you designate on your claim with modifier 26, Professional component) still adds $27.06.

Watch for Ortho/Ortho Edit Pairs

Mutually exclusive edits from CCI 16.1 list some orthopedic services on both sides of the component/comprehensive equation. For example, 22856 is a component of 22802 (Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments), 22818 (Kyphectomy, circumferential exposure of spine and resection of vertebral segment[s] [including body and posterior element[s]; single or 2 segments), and 22861.

Again, these edits carry a "1" modifier indicator, so you can override the pairing and report both services in some circumstances.

Ortho Work Is Part of Disc Procedures

While the edits involving anesthesia list the orthopedic procedure as more comprehensive, other non-mutually exclusive edits designate orthopedic services as the "less important" component service.

Aspiration code 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, orparavertebral tissue for diagnostic purposes) overrides several biopsy codes. These include 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]), 20240 (Biopsy, bone, open; superficial [e.g., ilium, sternum, spinous process, ribs, trochanter of femur]), 20250 (Biopsy, vertebral body, open; thoracic), and similar procedures.

Injection procedure 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]) includes splint and strapping services 29515 (Application of short leg splint [calf to foot]), 29540 (Strapping; ankle and/or foot), and others.

Disc arthroplasty code 22856 (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, cervical) includes manipulation 22505 (Manipulation of spine requiring anesthesia, any region).Similarly, related procedures 22861 (Revision including replacement of total disc arthroplasty [artificial disc],anterior approach, single interspace; cervical) and 22864 (Removal of total disc arthroplasty [artificial disc], anterior approach, single interspace; cervical) also include 22505.

Breakage allowed: CCI assigns a modifier indicator of "1" to each of these edit pairs, meaning you can override the edit by reporting the appropriate modifier (such as modifier 59, Distinct procedural service). For example, you might see this situation if the physician performs disc biopsy at L2-L3 and needle biopsy of the iliac crest, say s Heidi Stout, CPC, CCS-P, director of orthopedic coding services at The Coding Network.

Arthroscopy Overrides Anesthesia

The majority of non-mutually exclusive edits for orthopedics involve anesthesia codes 01400 (Anesthesia for open or surgical arthroscopioc procedures on knee joint; not otherwise specified) and 01402 (... total knee arthroplasty).

CCI 16.1 lists the anesthesia service as part of knee and upper leg procedures ranging from 27301 (Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region) and 27437 (Arthroplasty, patella; without prosthesis) to 27496 (Decompression fasciotomy, thigh and/or knee, 1 compartment [flexor or extensor or adductor]). A whopping 180 edits fall in this category.

Watch out: All of the anesthesia-related edits carry a "0" modifier indicator, so you cannot report the procedures together under any circumstances.

Fixation fix: Other non-mutually exclusive edits clarify that fluoroscopic guidance is part of fixation procedures 20696 (Application of multiplane [pins or wires in more than one plane], unilateral, external fixation with stereotactic computer-assisted adjustment [e.g., spatial frame], including imaging; initial and subsequent alignment[s], assessment[s], and computation[s] of adjustment schedule[s]) and 20697 (... exchange [i.e., removal and replacment] of strut, each).