Orthopedic Coding Alert

4 strategies that every ortho coder needs to know If your orthopedist performs several knee arthroscopes on the same patient on the same day, you-ll need to understand the multiple-scope rule to determine which procedures you can actually claim -- and get paid for. Important orthopedic exception: Keep in mind that the multiple-scope rule applies mainly to shoulder and knee procedures in the orthopedic practice, but it also affects those of the elbow, wrist and hip. On the other hand, it does not apply to ankle or metacarpophalangeal (MCP) arthroscopy, and it doesn't affect arthroscopically aided procedures (29851, 29855-29856, 29888-29889 and 29892). In addition, some surgical knee arthroscopies are excluded from the family -- specifically, 29866-29868. Follow these expert-approved tips to clinch your coding every time. 1. Look to CPT for Scope -Families- Before worrying about how to apply the multiple-endoscopy rule, you must first know why and when it applies. The multiple-endoscopy rule is Medicare's method to avoid paying twice (or more) for "inclusive" services by reimbursing only a portion of any scope performed at the same time as another scope of the same basic type, says Tara L. Conklin, CPC, a coding analyst for CodeRyte Inc. in Bethesda, Md. Here's how the rule works: CPT divides groups of similar codes into so-called "families." The first code (the base or "parent" code) describes the basic procedure. Following the base code, CPT lists any variants that "go beyond" (are more extensive than) the base code, says Marvel J. Hammer, RN, CPC, CHCO, owner of MJH Consulting, a healthcare reimbursement consulting firm in Denver. For example, consider this partial code family: - 29805 -- Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) - 29806 -- Arthroscopy, shoulder, surgical; capsulorrhaphy - 29807 -- - repair of SLAP lesion - 29819 -- - with removal of loose body or foreign body. In this case, 29806, 29807 and 29819 describe more extensive procedures than the family's base code, 29805, which they are listed under in CPT. In other words, 29806, 29807 and 29819 include all the work involved in 29805, plus something more. The multiple-scope rule applies only if two or more endoscopies the surgeon performs are members of the same code family, Conklin says. If the surgeon performs 29806 and 29807 during the same operative session, for instance, the multiple-scope rule applies. But if he performs a shoulder arthroscopy 29807 and a scope from a different code family, such as knee arthroscopy (for example, 29870, Arthroscopy, knee, diagnostic, with or without synovial biopsy [separate procedure]), you need not worry about the multiple-scope rule. In addition, you should not use modifier 51 (Multiple procedures) when the multiple-scope rule applies. 2. Always Include [...]