Orthopedic Coding Alert

Red flag: You may be wrong to bill the incisions and closures.

CCI edits 18.3 bundle the codes for wound repair with codes for interstitial fluid pressure monitoring, bone grafts, osteocutaneous flaps, electrical and ultrasound stimulation for bone healing, and radiofrequency ablation of bone tumor. Use the instruction below on reporting these together and advice on appending the right modifiers.

Differentiate Services with Modifiers

Here's a quick refresher on the codes for interstitial fluid pressure monitoring, bone grafts, osteocutaneous flaps, electrical and ultrasound stimulation for bone healing, and radiofrequency ablation of bone tumor:

• 20950 (Monitoring of interstitial fluid pressure [includes insertion of device, e.g., wick catheter technique, needle manometer technique] in detection of muscle compartment syndrome)
• 20955 (Bone graft with microvascular anastomosis; fibula)
• 20962 (Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsal)
• 20969 (Free osteocutaneous flap with microvascular anastomosis; other than iliac crest, metatarsal, or great toe)
• 20973 (Free osteocutaneous flap with microvascular anastomosis; great toe with web space)
• 20974 (Electrical stimulation to aid bone healing; noninvasive [nonoperative]) and 20975 (Electrical stimulation to aid bone healing; invasive [operative])
• 20979 (Low intensity ultrasound stimulation to aid bone healing, noninvasive [nonoperative])
• 20982 (Ablation, bone tumor[s] [e.g., osteoid osteoma, metastasis] radiofrequency, percutaneous, including computed tomographic guidance)

Append appropriate modifiers, such as modifier 59 (Distinct procedural service...) to the following codes when reporting them with the interstitial fluid pressure monitoring, bone grafts, osteocutaneous flaps, electrical and ultrasound stimulation for bone healing, and radiofrequency ablation of bone tumor. The following codes are column 2 codes for the codes for these procedures, and you will need to differentiate the two services provided.

• 12011 (Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) -- 12021 (Treatment of superficial wound dehiscence; with packing)
• 12051 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less) -- 12057 (Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm)
• 13100 (Repair, complex, trunk; 1.1 cm to 2.5 cm) -- 13153 (Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less [List separately in addition to code for primary procedure])

Note That Closure Is Inclusive

You may find it very unusual to use a wound repair code when codes for interstitial fluid pressure monitoring, bone grafts, osteocutaneous flaps, electrical and ultrasound stimulation for bone healing, and radiofrequency ablation of bone tumor. The CCI edits just intend that closure is inherent in the described procedures. The site of entry or puncture and suture in these procedures may not be described as wound repair. "Just as the surgical incision is inherent to any invasive procedure, so is the surgical closure," says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, Coder on Call, Inc., Milltown, New Jersey and orthopedic coding division director, The Coding Network, LLC, Beverly Hills, CA.

However, there can be exceptions to this rule. "Possible exceptions might be cases where the surgeon creates special closure configurations such as flaps or performs a skin graft," says Stout.