Orthopedic Coding Alert

New code book includes small helping of new spine codes and revisions.

The 2024 CPT^® changes for orthopedic surgery are few this year, including a new set of codes for vertebral body tethering (VBT), the addition of clarifying language for hallux valgus/bunion correction codes, and a few new and revised Category III (T) codes.

Check out this brief update on what you’ll see starting this month and for the rest of the year.

Meet Quartet of New Vertebral Body Tethering Codes

CPT^® 2024 introduces four new codes for vertebral body tethering (VBT), a procedure performed to treat adolescent idiopathic scoliosis.

Vertebral body tethering changes the growth of the spine to correct scoliosis. It allows the spine to continue to grow during treatment. Vertebral body tethering requires several small incisions. Small screws are placed along the outside edge of the spinal curve and a strong, flexible cord is threaded through the screws. When the cord is tightened, the spine straightens.

The new codes are:

• 22836 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed, up to 7 vertebral segments)
• 22837 (Anterior thoracic vertebral body tethering, including thoracoscopy, when performed, 8 or more vertebral segments)
• 22838 (Revision (eg, augmentation, division of tether), replacement, or removal of thoracic vertebral body tethering, including thoracoscopy, when performed)

Check Out These New, Revised Category III Codes

CPT^® also added one new Category III code you’ll want to note, while revising several others. The new T code is 0790T (Revision (eg, augmentation, division of tether), replacement, or removal of thoracolumbar or lumbar vertebral body tethering, including thoracoscopy, when performed).

The revised T codes are:

• 0656T (Anterior lumbar or thoracolumbar vertebral body tethering, up to 7 vertebral segments)
• 0657T (Anterior lumbar or thoracolumbar vertebral body tethering, 8 or more vertebral segments)

Coding Clarification: Bunion Correction

A small change with big implications has been made to the following codes (these are their 2024 descriptors):

• 28292 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method)
• 28296 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any method)
• 28295 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal metatarsal osteotomy, any method)
• 28297 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method)
• 28298 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal phalanx osteotomy, any method)
• 28299 (Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method)

The change: On codes 28292 through 28299, CPT^® added an another “with” to the base code description. For example, the 20292 code reads: “Correction, hallux valgus with bunionectomy, with sesamoidectomy, when performed.” (Emphasis added).

This change was necessary because coders incorrectly reported many codes in the 28292 through 28299 code family for hallux valgus correction without bunion resection. Adding “with” to the code description clarifies that the surgical procedures reported by codes 28292 through 28299 should inherently include removal of the bunion by excision or resection.

To prevent inappropriate reporting of code 28297, parenthetical notes were added following codes 28297 and 28740. The note after 28297 reads “For first metatarsal cuneiform joint fusion without concomitant removal of the distal medial prominence of the first metatarsal for hallux valgus correction, use 28740.”

The note after 28740 reads the same.

Remember 1 More Category III Code

There is one more T code on tap this year that you’ll want to note: 0814T (Percutaneous injection of calcium-based biodegradable osteoconductive material, proximal femur, including imaging guidance, unilateral)

This Category III code was established to report percutaneous injection of calcium-based biodegradable osteoconductive material. The procedure involves implanting a calcium-based, osteoconductive material into the lateral femoral cortex to form new bone in voids in the proximal femur of patients with disorders such as osteoporosis. The procedure is performed under imaging guidance.

Written by Heidi Stout, CPC, COSC, of Coder on Call, Inc., in Milltown, New Jersey.