Orthopedic Coding Alert

Check out this sneak peek to get a glimpse of the codes you'll be using in January.

If you've been frustrated about the lack of arthroscopic hip surgery codes that CPT offers, CPT 2011 will change that, with three new codes that debut on Jan. 1.

Be the first coder to glean what else is potentially new for your orthopedic practice, so that you can be proficient when Jan. 1 hits.

Caveat: Advice and information about the other new, revised, and deleted codes for 2011 should be clarified during the annual CPT Symposium, which takes place in  November.

Staff members from the Orthopedic Coding Alert and Codify will be reporting directly from the event, so look to future issues of this publication for further information and instruction.

Get Hip to Three New Arthroscopy Codes

As of Jan. 1, you'll benefit from the following three hip arthroscopy codes, which will be excellent additions to CPT, says Leslie A. Follebout, CPC, COSC, senior orthopaedic coder and auditor with The Coding Network:

• 29914 -- Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
• 29915 -- Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
• 29916 -- Arthroscopy, hip, surgical; with labral repair

These new codes "eliminates the use of 29999 (Unlisted procedure, arthroscopy) in these circumstances," says Susan Vogelberger, CPC, CPC-H, CPC-I, CMBS, CCP-P,  CEO of Healthcare Consulting and Education in Boardman, Ohio.

Eliminate mistakes: If you have billed femoroplasty, acetabuloplasty, or labral repair claims with open codes when the physician performed them through a scope, then you have been incorrectly billing these procedures. Also, if you've been reporting arthroscopic procedures 29861-29863 with modifier 22 (Increased procedural service), you have been inaccurate. The new additions to CPT 2010 will abolish these errors.

Note: These codes will be listed out-of-sequence in your CPT manual, but hopefully you're like "most coders [who] have adapted to the change in format by now," Vogelberger says. 

Cut to the Chase With Debridement Code Changes

In addition, you'll find that CPT has revised debridement codes to include the size of the area debrided, and will introduce new codes three new codes to describe additional areas that the physician debrides. The changes are as follows:

• 11042 (Revised) -- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less
• 11043 (Revised) -- Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less
• 11044 (Revised) -- Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less
• 11045 (New) -- Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
• 11046 (New) -- Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)
• 11047 (New) -- Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)

Brace For New Observation Additions

CPT adds to your E/M coding options with the introduction of three new observation codes, as follows:

• 99224 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history; Problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit.
• 99225 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit.
• 99226 -- Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit.

It isn't yet clear how CPT will instruct you to bill the subsequent observation codes, but the CPT Symposium should clarify this. Check back with the Orthopedic Coding Alert for the latest information.