Orthopedics Coding Update 2011 Lynn M. Anderanin, CPC, CPC-I, COSC 1 Subsequent Observation 99224 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
Subsequent Observation 99225 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 99226 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
11010 2010- Debridement including removal of foreign material associated with open fracture(s) and/or dislocation(s); skin and subcutaneous tissues 2011- 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 5 11011 and 11012 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); 11011-skin,subcutaneous tissue, muscle fascia, and muscle 11012-skin,subcutaneous tissue, muscle fascia, muscle, and bone 6 3
Integumentary Deletion 11040 and 11041 For debridement of skin, ie, epidermis and/or dermis only, see 97597, 97598 7 97597 and 97598 97597- 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 97598- each additional 20 sq cm of part thereof 8 4
11042 and 11045 11042 - Debridement; skin, and subcutaneous tissue (includes epidermis and dermis, if performed; first 20 sq cm or less +11045 - each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 9 11043 and 11046 11043 - Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); skin, subcutaneous tissue, and muscle first 20 sq cm or less +11046 - each additional 20 sq cm, or part thereof 10 5
11044 and 11047 11044 - Debridement; skin, subcutaneous tissue, muscle, and bone (includes epidermis, dermis, subcutaneous tissue, muscle, and/or fascia, if performed) first 20 sq cm or less +11047 - each additional 20 sq cm, or part thereof 11 Deletion General Musculoskeletal 20000 -Incision of soft tissue abscess (eg, secondary to osteomyelitis); superficial (For incision and drainage procedures, cutaneous/subcutaneous, see 10060,10061) 12 6
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 22551 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 22552 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
New Guideline for 22554 Do not report 22554 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 22551 If two physicians are performing discectomy and arthrodesis, they must bill 22551 with the 62 modifier, 63075 and 22554 can not be billed, even separately. 15 Description Changes 27065-27067 27065 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 27066 deep, with or without includes autograft, when performed 27067 with autograft requiring separate incision 16 8
Description Changes 27070-27071 27070 Partial excision wing of ilium, symphysis pubis, or greater trochanter of femur,(craterization, saucerization) (eg, osteomyelitis or bone abscess); superficial 27071 deep (subfascial or intramuscular) 17 Arthroscopy Hip Resequenced between 29863 and 29866 29914 Arthroscopy, hip, surgical; with with femoroplasty (ie, treatment of cam lesion) 29915 with acetabuloplasty (ie, treatment of pincer lesion) 29916 with labral repair 18 9
Stereotactic Deletion 61795 Stereotactic computer-assisted volumetric (navigational) procedure, intracranial, extracranial, or spinal (List separately in addition to code for primary procedure) 19 Stereotactic Navigation 61783 Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure) 61781-61782 Navigation, cranial 20 10
64479-64484 Revision 64479 Injection, anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance(fluoroscopy or CT); cervical or thoracic, single level +64480 cervical or thoracic, each additional level 64483 lumbar or sacral, single level +64484 lumbar or sacral, each additional level 21 64479-64484 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 64479 The guidelines have also been added for 64490-64495. If imaging is not used, report 20552-20553 If ultrasound guidance is used, report 0213T-0218T 22 11
76942 New Guideline Do not report 76942 in conjunction with 37760,37761,43232,43237,43242,45341, 45342,64479-64484, 64490-64495,76975, 0228T-0231T,0232T,0249T 23 77003 New Guideline Do not report 77003 in conjunction with 64479-64484, 64490-64495 Do not report guidance codes 77001,77002, 77003 for services in which fluoroscopic guidance is included in the descriptor 24 12
Extremity Ultrasound Deletion 76880 Ultrasound, extremity, nonvascular, real time with image documentation 25 Extremity Ultrasound 76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete 76882 Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific 26 13
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 76882 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. 28 14
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 2011 0234T-0259T- valid in 2011 http://www.ama-assn.org/ama/pub/physician-resources/solutionsmanaging-your-practice/coding-billing-insurance/cpt/about-cpt/categoryiii-codes.shtml 29 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, 20551,20600-20610,20926 76942,77002,77012,77021,86895 30 15
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
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 http://www.ama-assn.org/ama/pub/physicianresources/solutions-managing-your-practice/codingbilling-insurance/cpt/about-cpt/errata.shtml 34 17
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
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