Orthopedic Coding Alert

Overlooking these revised descriptors could land your claim into limbo.

The American Medical Association (AMA) has released its “sneak peek” at CPT® code changes for 2014, with several updates affecting orthopedic practices. The removal of shoulder prosthesis removals get the biggest changes for surgeons, but you’ll also not want to miss those related to radical resection, chemodenervation, and phone/Internet codes.

Educate Yourself on These Shoulder Additions

Orthopedic surgeons will benefit from two new codes that describe shoulder prosthesis removals, as follows:

• 23334 — Removal of prosthesis, includes debridement and synovectomy when performed; humeral or glenoid component
• 23335 — … humeral and glenoid components (e.g., total shoulder)

These shoulder prosthesis removal codes will offer more specificity than the previous options, which included 23331 (Removal of foreign body, shoulder; deep [e.g., Neer hemiarthroplasty removal]) and 23332 (…complicated [e.g., total shoulder]), both of which will be deleted effective Jan. 1.

With these deletions and additions, you’ll also have new code 23333 (… deep [subfascial or intramuscular]).

Revision: In addition, you should pay attention to the revised descriptors to 24160 (Implant removalRemoval of prosthesis, includes debridement and synovectomy when performed; elbow jointhumeral and ulnar components) and 24161 (… radial head).

Impact: “This will not affect much, because CPT® added a shoulder arthroplasty revision code last year (23474, Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component), and that was when we used the prosthesis removal code the most,” says Bill Mallon, MD, former medical director, Triangle Orthopedic Associates, Durham, N.C. “We still can’t use this new code for that, because there is a single code now for revision.”

In any case, “you’ll likely use the removal codes for the removal of shoulder prosthesis in cases of infection, when a new prosthesis is not inserted – although an antibiotic-impregnated cement spacer may be,” Mallon adds.

Highlight These Radical Resection of Tumor Codes

For ortho oncology surgeons, you have revisions to the radical resection of tumor codes (emphasis added):

• 23077 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of shoulder area; less than 5 cm
• 23079 — … 5 cm or greater
• 25077 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of forearm and/or wrist area; less than 3 cm
• 25078 — … 3 cm or greater
• 26117 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of hand and/or finger; less than 3 cm
• 26118 — … 3 cm or greater
• 27049 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of pelvis and hip area; less than 5 cm
• 27059 — … 5 cm or greater
• 27329 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of thigh and knee area; less than 5 cm
• 27364 — … 5 cm or greater
• 27615 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of leg and ankle area; less than 5 cm
• 27616 — … 5 cm or greater
• 28046 — Radical resection of tumor (eg, malignant neoplasmsarcoma), soft tissue of foot or toe; less than 3 cm
• 27059 — … 3 cm or greater

In all of these codes, “malignant neoplasm” is replaced by “sarcoma.”

Start Counting Muscles With Chemodenervation

If your practice includes physiatrists or orthopedists who perform Botox injections for spastic extremities, you should be aware of new chemodenervation codes.

2013 added one new chemodenervation code to your options (64615, Chemodenervation of muscle[s]; muscle[s] innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral [e.g., for chronic migraine]). The descriptors for the chemodenervation code family (64612-64615) each apply to both single and multiple muscles in a particular area (such as the neck, extremity, or trunk).

That’s not the case with the new chemodenervation codes for 2014, which specify the number of extremities and muscles the physician treats. The new codes and their descriptors are as follows:

• 64642 – Chemodenervation of one extremity; 1-4 muscle(s)
• 64643 – … each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)
• 64644 – Chemodenervation of one extremity; 5 or more muscle(s)
• 64645 – … each additional extremity, 5 or more muscle(s) (List separately in addition to code for primary procedure
• 64646 – Chemodenervation of trunk muscle(s);
• 1-5 muscle(s)
• 64647 – … 6 or more muscle(s).

Also note: Chemodenervation codes 64613 and 64614 will be deleted, effective Jan. 1, 2014, but 64615 will remain in effect.

Impact: “I think these are a great improvement from the existing chemodenervation codes,” says Marvel J. Hammer, RN, CPC, CCS-P, ACS-PM, CHCO, owner of MJH Consulting in Denver, Co. “There is better separation anatomically between injections into extremity muscles versus trunk muscles. And there is clarification as to whether these codes can be reported bilaterally.”

Rejoice in New Phone/Internet Codes

When Medicare stopped paying for consultations in 2010, you probably thought you’d never see another of these codes making its debut in a CPT® book — but that’s exactly what you’ll find when you crack open CPT® 2014.

Effective Jan. 1, CPT® will include four new codes that describe the work of two medical professionals who discuss a patient’s condition via phone or Internet, as follows:

As in the past, these new codes are consultative in nature, which means you’ll have to provide a written report back to the requesting physician to qualify for the code, as indicated by the phrase “including a verbal and written report” (emphasis added). It isn’t clear yet whether Medicare will include payment for these codes, since they are consultations, but keep an eye on the Orthopedic Coding Alert for more on whether these are payable once the 2014 Medicare Physician Fee Schedule is released.