Orthopedics Coding Update 2011

Transcription

1 Orthopedics Coding Update 2011 Lynn M. Anderanin, CPC, CPC-I, COSC 1 Subsequent Observation Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: Problem focused interval history Problem focused examination Medical decision making that is straightforward or of low complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 15 minutes at the bedside and on the patient's hospital floor or unit. 2 1

2 Subsequent Observation Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components : Expanded problem focused interval history Expanded problem focused examination Medical decision making of moderate complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 25 minutes at the bedside and on the patient's hospital floor or unit. 3 Subsequent Observation Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components Detailed interval history Detailed examination Medical decision making of high complexity Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant complication or a significant new problem. Physicians typically spend 35 minutes at the bedside and on the patient's hospital floor or unit. 4 2

3 Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin and subcutaneous tissues Debridement including removal of foreign material associated with at the site of an open fracture(s) and/or an open dislocation(s) (eg. Excisional debridement); skin and subcutaneous tissues and Debridement including removal of foreign material associated with at the site of an open fracture(s) and/or an open dislocation(s) (eg. Excisional debridement); skin,subcutaneous tissue, muscle fascia, and muscle skin,subcutaneous tissue, muscle fascia, muscle, and bone 6 3

4 Integumentary Deletion and For debridement of skin, ie, epidermis and/or dermis only, see 97597, and Debridement of devitalized tissue from wound(s), selective debridement, without anesthesia (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg. Fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm) with or without including topical application(s), wound assessment, may include use of a whirlpool, when performed, and instruction(s) for ongoing care per session; total wound(s) surface area less than or equal to 20 square centimeters first 20 sq cm or less each additional 20 sq cm of part thereof 8 4

5 11042 and Debridement; skin, and subcutaneous tissue (includes epidermis and dermis, if performed; first 20 sq cm or less each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) and Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); skin, subcutaneous tissue, and muscle first 20 sq cm or less each additional 20 sq cm, or part thereof 10 5

6 11044 and Debridement; skin, subcutaneous tissue, muscle, and bone (includes epidermis, dermis, subcutaneous tissue, muscle, and/or fascia, if performed) first 20 sq cm or less each additional 20 sq cm, or part thereof 11 Deletion General Musculoskeletal Incision of soft tissue abscess (eg, secondary to osteomyelitis); superficial (For incision and drainage procedures, cutaneous/subcutaneous, see 10060,10061) 12 6

7 CPT Professional Edition 2011 At the beginning of each fracture section: Coding Tip Reporting for Categories of Manipulation and/or Fracture The codes for treatment of fractures or joint injuries(dislocations) are categorized by the type of manipulation(reduction) and stabilization (fixation or immobilization). These codes can apply to either open(compound) or closed fractures or joint injuries. 13 Anterior Interbody Arthrodesis Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 14 7

8 New Guideline for Do not report in conjunction with 63075, even if performed by separate providers. To report anterior cervical discectomy and interbody fusion at the same level during the same session, use If two physicians are performing discectomy and arthrodesis, they must bill with the 62 modifier, and can not be billed, even separately. 15 Description Changes Excision of bone cyst or benign tumor (wing of ilium, symphysis pubis, or greater trochanter of femur); superficial, with or without includes autograft, when performed deep, with or without includes autograft, when performed with autograft requiring separate incision 16 8

9 Description Changes Partial excision wing of ilium, symphysis pubis, or greater trochanter of femur,(craterization, saucerization) (eg, osteomyelitis or bone abscess); superficial deep (subfascial or intramuscular) 17 Arthroscopy Hip Resequenced between and Arthroscopy, hip, surgical; with with femoroplasty (ie, treatment of cam lesion) with acetabuloplasty (ie, treatment of pincer lesion) with labral repair 18 9

10 Stereotactic Deletion Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure) 19 Stereotactic Navigation Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure) Navigation, cranial 20 10

11 Revision Injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance(fluoroscopy or CT); cervical or thoracic, single level cervical or thoracic, each additional level lumbar or sacral, single level lumbar or sacral, each additional level Notes For these injections under ultrasound guidance, use 0228T-0231T These are unilateral injections, to report bilateral, use modifier 50 For an injection at T12-L1 use The guidelines have also been added for If imaging is not used, report If ultrasound guidance is used, report 0213T-0218T 22 11

12 76942 New Guideline Do not report in conjunction with 37760,37761,43232,43237,43242,45341, 45342, , ,76975, 0228T-0231T,0232T,0249T New Guideline Do not report in conjunction with , Do not report guidance codes 77001,77002, for services in which fluoroscopic guidance is included in the descriptor 24 12

13 Extremity Ultrasound Deletion Ultrasound, extremity, nonvascular, real time with image documentation 25 Extremity Ultrasound Ultrasound, extremity, nonvascular, real-time with image documentation; complete Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific 26 13

14 Extremity Ultrasound A complete ultrasound examination of an extremity (76881) consists of real time scans of a specific joint that includes examination of the muscles, tendons, joint, other soft tissue structures, and any identifiable abnormality. 27 Extremity Ultrasound Code refers to an examination of an extremity that would be performed primarily for evaluation for muscles, tendons, joints, and/or soft tissues. This is a limited examination of the extremity where a specific anatomic structure such as a tendon or muscle is assessed. In addition, the code would be used to evaluate a soft-tissue mass that may be present in an extremity where knowledge of its cystic or solid characteristics is needed

15 Category III Changes Codes 0208T-0259T added in CPT 2011 Sunset dates now added to each code 0208T-0233T- valid in 2010, but published in T-0259T- valid in Platelet Rich Plasma 0232T Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed Sunset January 2016 Do not report 0232T in conjunction with 20550, 20551, , ,77002,77012,77021,

16 Rib Fracture 0245T Open treatment of rib fracture requiring internal fixation, unilateral; 1-2 ribs 0246T Open treatment of rib fracture requiring internal fixation, unilateral; 3-4 ribs 0247T Open treatment of rib fracture requiring internal fixation, unilateral; 5-6 ribs 0248T Open treatment of rib fracture requiring internal fixation, unilateral; 7 or more ribs 31 Modifier 50 change 50 Bilateral Procedure: Unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. The word operative has been deleted from the description 32 16

17 Modifier Changes 76, 77, 78 Modifiers 76, 77, and 78 or other qualified health care professional has been added to the description Modifiers 76 and 77 Note has been added to note these modifiers cannot be used with E/M services. 33 CPT 2011 Errata

18 ICD-10-CM DRAFT Official Guidelines, Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue a. Site and laterality Most codes within this chapter have site and laterality designations. The site represents either the bone, joint, or muscle involved c. Coding of pathologic fractures 7 th character A is for use as long as the patient is receiving active treatment for a fracture. 7 th character D is to be used for encounters after the patient has completed active treatment 35 ICD-10-CM DRAFT Chapter 19: Injury, poisoning, and certain other consequences of external causes c.coding Traumatic Fractures 1. Initial and Subsequent Encounter for Fractures Traumatic fractures are coded using the appropriate 7 th character extension for the initial encounter (A,B,C) while the patient is receiving active treatment. Fractures are coded using the appropriate 7 th character extension for subsequent care for encounters after active treatment is completed and routine care for the fracture is being given. Care of complications of fractures such as malunion/nonunion should be reported with the appropriate 7 th character extensions for subsequent care with nonunion(k,m,n) or subsequent care of malunion (P,Q,R) 36 18

19 ICD-10-CM DRAFT S52.5 Fracture of lower end of radius S52.50 Unspecified fracture of lower end of radius-3 codes S52.51 Fracture of radial styloid process-6 codes S52.52 Torus fracture of lower end of radius-3 codes S52.53 Colles Fracture-3 codes 37 ICD-10-CM DRAFT S52.54 Smith s fracture - 3 codes S52.55 Other extra-articular fracture of lower end of radius-3 codes S52.56 Barton s fracture-3 codes S52.57 Other intra-articular fracture of lower end of radius- 3 codes S52.59 other fractures of the lower end of radius-3 codes 38 19