Medicare Compliance & Reimbursement

CMS prices two new codes at over $1,000 -- will you recoup that pay?

You can stop feeling overwhelmed by the slew of new orthopedic-specific codes that will affect your practice in 2009 by simplifying the multitude of changes into four subjects:

• multiplane external fixation,

• arthroplasty,

• pelvic fasciotomy, and

• plantar common digital nerve injection.

• 20696 -- Application of multiplane (pins or wires in more than one plane), unilateral, external fixation with stereotactic computer -assisted adjustment (e.g., spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)

• 20697 -- ... exchange (i.e., removal and replacement) of strut, each.

Highlight: These codes include a lot of services (such as subsequent alignments and removal and replacement). For that reason, CMS prices these codes with high relative value units (RVU). Code 20696 has 28.14, and 20697 has 33.09. If you multiply that by 36.0666, the 2009 conversion factor, youll equal more than $1000 per procedure.

Rationale: Until recently, the data lagged behind to create Category I codes for cervical total disc arthroplasty, explained Charles Mick, MD, a Northampton, MA-based Pioneer Spine and Sports physician in Spine Surgery/ Neurosurgery at the CPT and RBRVS 2009 Annual Symposium in Chicago.

• 22856 -- Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), single interspace, cervical

• 22861 -- Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

• 22864 -- Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical.

The descriptors are almost identical to the Category III versions.

Be careful: Be cautious about 22856, which includes the term decompression.

Why: You should consider the decompression performed at the interspace where the physician is placing the artificial disc as an inclusive part of the procedure. In other words, you should not report it separately. Decom-pression codes are difficult to apply to dictated reports, warns Pat Tietz, CPC, coder for The Twin Cities Spine Center in Minneapolis. Also, remember your physician needs to qualify the segment.

Many coders are hopeful this will change how payers view these procedures. The transition to regular codes at least suggests insurance payers can pay for the total disc arthroplasty more easily, says Lori Montanez, CPC, coder at Spine Orthopaedic & Rehabilitation Center (SORC) in Albuquerque, N.M. Many payers said, due to the Category III code, their system automatically denied it for procedure experimental.

Other experts are dubious. I am glad CPT changed these services into regular CPT codes; its a step in the right direction -- but unfortunately this doesnt mean insurers will reimburse for them, warns Regina H. Tinney, CPC, coding specialist at Crossroads Healthcare Management in College Station, Texas.

• 27027 -- Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (e.g., gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tenso fascia lata muscle), unilateral

• 27057 -- Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (e.g., gluteus medius-minimus, gluteus maximus, iliopsoas and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilateral.

• 64455 -- Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (e.g., Morton's neuroma)

• 64632 -- Destruction by neurolytic agent; plantar common digital nerve.

If your physician injects a steroid or anesthetic agent for pain relief in 2009, use 64455. In contrast, 64632 describes nerve destruction or chemodenervation.