Orthopedic Coding Changes for Lynn M. Anderanin, CPC,CPC-I, COSC Vertebroplasty 22520- Percutaneous vertebroplasty, 1 vertebral body, unilateral or bilateral injection; thoracic 22520- Percutaneous vertebroplasty, (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection; thoracic Same revision to 22521 and 22522 2 1
Spinal Arthrodesis 22633- 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 22634- each additional interspace and segment 3 Guidelines for 22614 and 22632 Can be used with any of the following 22600 (22614) 22610 (22614) 22612 22630 22633 22634 4 2
Posterior Arthrodesis 22610- Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or without lateral transverse technique) 22610- Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique when performed) Same revision to 22612 5 Percutaneous Discectomy 62287- 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) 62287- 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
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 7 63020- 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 63020- Laminotomy (hemilaminotomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical 8 4
Spinal Instrumentation When removing or revising instrumentation only the insertion should be reported You can not report 22849, 22850, or 22852 with 22840-22848 9 62310- 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 62311 Spinal Injection 62310- 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
Paravertebral Facet Nerve Destruction 64626- Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, single level 64627- Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or thoracic, each additional level (List separately in addition to code for primary procedure) 64633- Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT), cervical or thoracic, single facet joint 64634- 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 64622- Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, single level 64623- Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral, each additional level (List separately in addition to code for primary procedure) 64635- Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT), lumbar or sacral, single facet joint 64636- 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
Sacroiliac Joint Injection 27096- Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid 73542- Sacroiliac joint arthrography, has been deleted 27096- Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed 13 Knee Arthroscopy 29880- Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) Same revision for 29881 29880- 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
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 29880-29881 Will be reported with 29882-29883 Will be reported for 29874 with 29880-29883 15 Arthroscopic Acromioplasty 29826- Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release + 29826- 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
Multi-layer Compression System 29581- Application of multilayer venous wound compression system, below knee 29581- Application of multilayer compression system; leg (below knee) 17 New CPT Codes for Compression Systems 29582- Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed 29583- upper arm and forearm 29584- upper arm, forearm, hand, and fingers 18 9
Xialfex Injection 20527- Injection, enzyme (eg, Collagenase), palmar fascial cord (i.e., Dupuytren s contracture) 26341- Manipulation, palmar fascial cord, (i.e., Dupuytren s cord), post enzyme injection (eg, Collagenase), single cord HCPCS code for Xiaflex - J0775 19 20 10
Spinal X-rays 72114- Radiologic examination, spine, lumbosacral; complete, including bending views 72114- Radiological examination, spine, lumbosacral; complete, including bending views, minimum of 6 views 21 Spinal X-rays 72120- Radiologic examination, spine, lumbosacral, bending views only, minimum of 4 views 72120- Radiologic examination, spine, lumbosacral, bending views only, 2 or 3 views 22 11
Deleted Bone Studies 77079- Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 77083- Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), 1 or more sites 23 Tissue Cultured Autograft 15150- Tissue cultured epidermal autograft, trunk, arms, legs; first 25 sq cm or less 15150- Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or less Same revision to 15151-15157 24 12
New Codes to Skin Grafts 15271- 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 15272- 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) 15273- 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 15274- 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 15275- 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 15276- 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) 15277- 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 15278- 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
Deleted Skin Grafts 15170-15171 15340-15341 15175-15176 15360-15361 15300-15301 15365-15366 15320-15321 15400-15401 15330-15331 15420-15421 15335-15336 15430-15431 27 E/M Changes Initial Observation- Revised codes 99218-99220 Prolonged Service- Revised codes 99354-99359 28 14