Orthopedic Coding Changes for 2012

Transcription

1 Orthopedic Coding Changes for Lynn M. Anderanin, CPC,CPC-I, COSC Vertebroplasty Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection; thoracic Percutaneous vertebroplasty, (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic Same revision to and

2 Spinal Arthrodesis Arthrodesis combined posterior or posterior lateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression),single interspace and segment; lumbar each additional interspace and segment 3 Guidelines for and Can be used with any of the following (22614) (22614)

3 Posterior Arthrodesis Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or without lateral transverse technique) Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique when performed) Same revision to Percutaneous Discectomy Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy) Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar 6 3

4 Percutaneous Laminotomy/Laminectomy Effective July 1, 0274T Percutaneous laminotomy/laminectomy (intralaminar 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 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, including open and endoscopically-assisted approaches; 1 interspace, cervical Same revision for 63030,63035 Laminotomy Laminotomy (hemilaminotomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical 8 4

5 Spinal Instrumentation When removing or revising instrumentation only the insertion should be reported You can not report 22849, 22850, or with Injection, single (not via indwelling catheter), not including neurolytic substances, with or without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; cervical or thoracic Same revisions to Spinal Injection Injections of diagnostic or therapeutics substance(s) (including anesthetic antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic 10 5

6 Paravertebral Facet Nerve Destruction Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure) Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT), cervical or thoracic, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional facet joint, (list separately in addition to code for primary procedure 11 Paravertebral Facet Nerve Destruction Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure) Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT), lumbar or sacral, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional facet joint, (list separately in addition to code for primary procedure) 12 6

7 Sacroiliac Joint Injection Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid Sacroiliac joint arthrography, has been deleted Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 13 Knee Arthroscopy Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) Same revision for Arthroscopy, knee surgical; with meniscectomy (medial and lateral including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s) when performed 14 7

8 G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee MY OPINION OF CHANGES Will not be reported with Will be reported with Will be reported for with Arthroscopic Acromioplasty Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release Arthroscopy, shoulder, surgical, decompression of subacromial space with partial acromioplasty with coracoacromial ligament (i.e., arch) release, when performed (list separately in addition to code for primary procedure) 16 8

9 Multi-layer Compression System Application of multilayer venous wound compression system, below knee Application of multilayer compression system; leg (below knee) 17 New CPT Codes for Compression Systems Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed upper arm and forearm upper arm, forearm, hand, and fingers 18 9

10 Xialfex Injection Injection, enzyme (eg, Collagenase), palmar fascial cord (i.e., Dupuytren s contracture) Manipulation, palmar fascial cord, (i.e., Dupuytren s cord), post enzyme injection (eg, Collagenase), single cord HCPCS code for Xiaflex - J

11 Spinal X-rays Radiologic examination, spine, lumbosacral; complete, including bending views Radiological examination, spine, lumbosacral; complete, including bending views, minimum of 6 views 21 Spinal X-rays Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views Radiologic examination, spine, lumbosacral, bending views only, 2 or 3 views 22 11

12 Deleted Bone Studies Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), 1 or more sites 23 Tissue Cultured Autograft Tissue cultured epidermal autograft, trunk, arms, legs; first 25 sq cm or less Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less Same revision to

13 New Codes to Skin Grafts Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area or part thereof (list separately in addition to code for primary procedure) Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) 25 Additional Skin Graft Codes Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area or part thereof (list separately in addition to primary procedure) Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof (list separately in addition to primary procedure) 26 13

14 Deleted Skin Grafts E/M Changes Initial Observation- Revised codes Prolonged Service- Revised codes