Orthopedic Coding Alert

Plus: Don’t miss these biopsy, fluoroscopic guidance revisions.

As you gear up for the end of the year, ‘tis the season to gear up for CPT^® 2017 — and we’ve got your orthopedic coding highlights.

Read on to make sure you don’t miss what will be different when January 1 rolls around and avoid potential claim disasters.

1. Submit Separate Sedation Code For These Services

CPT^® 2017 makes a singular change to hundreds of codes, some of which that orthopedic providers might report — remove the moderate sedation “bull’s eye” symbol from the code.

These orthopedic related codes include:

• 20982 — Ablation therapy for reduction or eradication of 1 or more bone tumors (e.g., metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequency
• 20983 — …Cryoablation
• 22510-22512 — Percutaneous vertebrolasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance …
• 22513-22515 — Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance …
• 22526-22527 — Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance …
• 0200T-0201T — Percutaneous sacral augmentation (sacroplasty) …

What that symbol means: “The bull’s eye means that the procedure includes the moderate sedation service, so you can’t separately report the diagnostic or therapeutic procedure code with a moderate sedation code,” explains Marcella Bucknam, CPC, CPC-I, CCS-P, CPC-H, CCS, CPC-P, COBGC, CCC, internal audit manager with PeaceHealth in Vancouver, Wash. “For a code that no longer has the bull’s eye symbol [such as those above], you’ll be able to separately report one of the new moderate sedation codes if your surgeon sedates a patient for a procedure that she is performing, or for a procedure that someone else is performing,” she says.

You have new codes to reflect the moderate sedation services, which depends upon who performs them.

Same physician: If performed by the surgeon who is performing the procedure, you should choose either:

• 99152 — Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older
• 99153— … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

You will delete codes 99144 and 99145.

Different physician: If performed by a provider who is not performing the procedure, you should choose from either:

• 99156 — Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient age 5 years or older
• 99157— … each additional 15 minutes intraservice time (List separately in addition to code for primary service).

You will delete codes 99149 and 99150.

Example: Your orthopedic physician performs cryoablation (20983) on a patient with a metastatic bone tumor, and another physician performs 25 minutes of sedation. The physician performing the conscious sedation would report 99156 and 99157, says Heidi Stout, BA, CPC, COSC, PCS, CCS-P, with Coder on Call, Inc., in Milltown, New Jersey. So in this case, the orthopedic physician who did the procedure would not bill 99157.

Payment decrease: At the same time as these codes lose the bull’s eye, CMS is proposing to lower the payment to account for the change in how you use the codes. According to the MPFS proposed rule, “we are proposing to maintain current values for the procedure codes less the work RVUs associated with the most frequently reported corresponding moderate sedation code, so that practitioners furnishing the moderate sedation services previously considered to be inherent in the procedure will have no change in overall work RVUs.”

2. Check Out These New Codes for Biomechanical Devices

You have new biomechanical device codes to learn, as of January 1. They are:

• 22853 — Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
• 22854 — Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
• 22859 — Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmeth­acrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
• 22867 — Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
• 22868 — … second level (List separately in addition to code for primary procedure)
• 22869 — Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
• 22870 — … second level (List separately in addition to code for primary procedure).

“CPT^® has added language to the code description making it clear that these codes include integrated fixation devices and that you should not report an additional instrumentation code,” Stout says.

Remember, you will delete 22851. Also, codes 22869 and 22870 will replace Category III codes 07171T and 0172T.

3. Adjust Your Pelvic Ring Fracture Treatment Codes

You’ve got two new codes for the closed treatment of the pelvic ring as follows:

• 27197 — Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without manipulation
• 27198 — … with manipulation, requiring more than local anesthesia (ie, general anesthesia, moderate sedation, spinal/epidural)

You will delete old codes 27193 and 27194.

4. Don’t Miss These Revisions

You’ll need to adjust these biopsy code descriptor to read as follows (emphasis added):

• 20240 — Biopsy, bone, open; superficial (eg, ilium sternum, spinous process, rib, sternum patella, spinous olecranon process, calcaneus, tarsal, ribs metatarsal, trochanter of femur carpal, metacarpal, phalanx)
• 20245— … deep (eg, humerus humeral shaft, ischium, femur femoral shaft).

Check out how your hallux rigidus correction code will change (emphasis added). You’ll also have a brand new code underneath:

• 28289 — Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant
• 28291 (new) — … with implant.

“Foot and ankle surgeons will frequently use and appreciate 28291,” Stout says.

You’ll delete 28290.

Similarly, you have the following changes for hallux valgus correction codes. “These are much needed changes that reflect current surgical techniques used to treat hallux valgus,” Stout says. They are (emphasis added):

• 28292 — Correction, hallux valgus (bunion)(bunionectomy), with sesamoidectomy or without , when performed; Keller, McBride with resection of proximal phalanx base, or Mayo type procedure when performed, any method
• 28296 — … with distal metatarsal osteotomy, (eg, Mitchell, Chevron, or concentric type procedures)any method
• 28295 — … with proximal metatarsal osteotomy, any method
• 28297 — … Lapidus-type procedure with first metatarsal and medial cuneiform joint arthrodesis, any method
• 28298 — … by with proximal phalanx osteotomy, any method
• 28299 — … by with double osteotomy, any method.

You will delete 28293 and 28294.

Fluoroscopic guidance did not escape CPT^® 2017’s notice either. Here’s how you’ll see it change in January:

• 77002 — Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure)
• 77003 — Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure).

5. Don’t Miss These New Category III Codes

You’ve got two category III codes to learn as of January 1. They are:

• 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
• 0275T— … lumbar.

You’ll delete 0019T, 0169T, 0171T, and 0172T.