Orthopedic Coding Alert

Equip yourself with new codes and revisions

With the 2012 codes being applicable, you will need to know the new and the revised codes to ensure you report correct and earn your deserved payment. You will need to be specifically careful in reporting the procedures and practices that have revised or new codes. Some of the new codes include those for palmar enzyme injections, lumbar arthrodesis, and limb compression.

Report Enzyme Injection in Palm

CPT® introduces a new code for palmar enzyme injections. Your surgeon may report a painless thickening and contracture of tissues beneath the skin in the palmar surface of the hands and fingers. Not all fingers may be involved. In addition your surgeon may document that the finger(s) were bent due to contraction of the skin and underlying tissues. This condition is called Dupuytren's contracture. The cause of the contraction is not usually known. "A non-operative option to treat this is exercises and splints, but more severe contractures have often needed surgical release in the past, in which surgery is done to release the contracted fascia and other soft issues," says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C. A newer approach is collagenase injections given locally into the scarred or fibrous tissue. The enzymes breakdown the fibrosis and ease the contracture. You report these injections as 20527 (Injection, enzyme [eg, collagenase], palmar fascial cord [ie, Dupuytren's contracture]).

Report Lumbar Arthrodesis

Make sure you use new codes when reporting lumbar arthodesis. When your surgeon does an arthrodesis adopting a posterior approach in a single interspace of the lumbar segment, you will report this with 22633 (Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace [other than for decompression], single interspace and segment; lumbar). For every additional interspace or segment, you report +22634 (each additional interspace and segment [List separately in addition to code for primary procedure]).

Limb Compression Has New Codes

The application of wound compression systems will become more site specific in 2012. The venous compressions are done for varicose veins, postphlebitis syndrome, atherosclerosis, chromic venous hypertension, or stasis ulcers in the limb(s). You report 29582 (thigh and leg, including ankle and foot, when performed) for the compression in the lower limb and 29584 (upper arm, forearm, hand, and fingers) for that in the upper limb.

Report the Percutaneous Spinal Procedures

Percutaneous decompression of spinal nerves has a new code. You report this irrespective of the laterality, number of levels, or endoscopy. When your surgeon adopts a percutaneous, fluoroscopic, or endoscopic approaches for a unilateral or bilateral laminotomy or laminectomy to decompress the neural elements, you report 0274T (Percutaneous laminotomy/laminectomy [interlaminar approach] for decompression of neural elements, [with or without ligamentous resection, discectomy, facetectomy, and/or foraminotomy], any method, under indirect image guidance [eg, fluoroscopic, CT], with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic) for the procedure in the cervical or thoracic spine, and 0275T (lumbar) that in the for the lumbar spine.

Editor's note: Look for more CPT® 2012 orthopedic coding updates and specific instructions in upcoming issues of Orthopedic Coding Alert.