Orthopedic Coding Alert

Medicare assigned 37.23 nonfacility RVUs to 63050, totaling payment of about $1,410, and assigned 42.36
nonfacility RVUs to 63051, giving it a base rate of about $1,605.
 
According to the AMA's CPT Changes 2005: An Insider's View, these new codes "involve procedures which leave portions of the posterior elements intact," unlike the existing posterior decompression codes 63015 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than two vertebral segments; cervical) and 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical), which involve complete removal of the posterior spinal elements.
 
Good news: The new RVUs demonstrate the complexity that goes into the "open-door" laminoplasty that the new codes describe. "Code 63015 only pays about $1,357, and 63001 pays about $1,098, so Medicare clearly understood the additional difficulty that goes into the open-door laminoplasty," says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky.
 
Knee Procedures Score High RVUs

Medicare plans to pay about $1,050 for the new mosaicplasty code 29866 (Arthroscopy, knee, surgical; osteochondral autograft[s] [e.g., mosaicplasty] [includes harvesting of the autograft]), and about $1,249 for the corresponding mosaicplasty with allograft code 29867 (Arthroscopy, knee, surgical; osteochondral allograft [e.g., mosaicplasty]).
 
In addition, Medicare assigned a healthy 44.71 non-facility total RVUs to the new meniscal transplantation code 29868 (Arthroscopy, knee, surgical; meniscal transplantation [includes arthrotomy for meniscal insertion], medial or lateral), which will bring about $1,694 for this procedure.
 
Caution: "Remember that 29868 already includes the $600 to $650 base pay that you'd get for the meniscectomy itself if you perform it in the same compartment as the transplant," Corcoran says, "so don't bill the meniscectomy (29881-29882) separately."

Wound VAC Code Payment Doesn't Materialize

Many orthopedic coders were thrilled to hear that the AMA created two new codes to represent wound vacuum-assisted closure (VAC) services this year, but the Fee Schedule failed to deliver any RVUs to codes 97605 (Negative pressure wound therapy [e.g., vacuum-assisted drainage collection], including topical application[s], wound assessment, and instruction[s] for ongoing care, per session; total wound[s] surface area less than or equal to 50 square centimeters) and 97606 (... total wound[s] surface area greater than 50 square centimeters).

Although CPT Changes 2005 states that these procedures require "work and practice expense different than any of the procedures considered to be selective debridement in the 97000 series," the RVU Committee assigned "B" status indicators to both codes.
 
Bad news: "A 'B' status indicator means that no separate payment will be made for the code," says Marvel J. Hammer, RN, CPC, CCS-P, CHCO, president of MJH Consulting in Denver. "In most instances, I have not seen individual carriers then price these services separately."
 
In addition, the Nov. 15, 2004, Federal Register explains that, although the review board recommended 0.55 work RVUs for 97605 and 0.60 for 97606, CMS disagreed, stating that when the wound VAC service "does not encompass selective debridement, we consider this service to represent a dressing change and will not make separate payment."
 
If your orthopedic practice performs a negative-pressure wound therapy service that also requires selective debridement, CMS will bundle the wound VAC service into the new debridement codes 97597 (Removal of devitalized tissue from wound[s], selective debridement, without anesthesia [e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may include use of a whirlpool, per session; total wound[s] surface area less than or equal to 20 square centimeters) and 97598 (... total wound[s] surface area greater than 20 square centimeters).
 
The remaining new codes, along with their nonfacility total RVU assignments, in chart.