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Orthopedic Coding Alert

2005 Sneak Peak:

Say Goodbye to Ambiguity With New Mosaicplasty Codes

Published on Sat Oct 09, 2004

Check out our preview of the new CPT codes that should take effect on Jan. 1

If you've grown tired of billing "T" codes for your mosaicplasty and ACI procedures, rejoice: CPT 2005 will introduce new mosaicplasty and autologous chondrocyte implantation (ACI) codes, along with several other new codes for orthopedic procedures. But if you were expecting new kyphoplasty CPT codes, you may be disappointed.

Look for 8 New Surgery Codes

The new CPT coding books haven't been published yet, but sources tell Orthopedic Coding Alert to expect five new codes in the musculoskeletal section of CPT 2005, and three new spine surgery codes:

  • 27412 - Autologous chondrocyte implantation, knee

  • 27415 - Osteochondral allograft, knee, open

  • 29866 - Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft)

  • 29867 - Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty)

  • 29868 - Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral

  • 63050 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments

  • 63051 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini-plates), when performed)

  • +63295 - Osteoplastic reconstruction of dorsal spinal elements, following primary intraspinal procedure (list separately in addition to code for primary procedure).

    Possible rationale: The AMA most likely established the new codes 29866 and 29867 to replace 0012T (Arthroscopy, knee, surgical, implantation of osteochondral graft[s] for treatment of articular surface defect; autografts) and 0013T (... allografts).  But remember that just because the AMA establishes a code for a procedure, there's no guarantee that your insurer will pay for the service. Because some payers were sketchy about mosaicplasty payment before the AMA introduced the new code, that probably won't change.

    "It will be nice not to have to deal with level-three codes for the osteochondral grafts and meniscal transplantation," says Ryan Price, CPC, CCS-P, manager of coding operations at Aviacode, a coding outsourcing company in Salt Lake City.

    As soon as CMS publishes its 2005 Physician Fee Schedule, Orthopedic Coding Alert will update you on applicable RVUs for the new codes.

    Bad news: Unfortunately, coders will have to continue billing kyphoplasty claims with HCPCS codes S2362 (Kyphoplasty, one vertebral body, unilateral or bilateral injection) and S2363 (Kyphoplasty, one vertebral body, unilateral or bilateral injection; each additional vertebral body [list separately in addition to code for primary procedure]). Alternatively, some payers request that you report 22899 (Unlisted procedure, spine) for kyphoplasty, says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.

    Prepare to Update Your DEXA, Wound Vac Codes

    You will have more flexibility when you code DEXA scans and vacuum-assisted drainage collection (wound vac) procedures in 2005, with three new codes:

  • 76077 - Dual energy x-ray absorptiometry (DEXA), bone density study, one or more sites; vertebral fracture assessment

  • 97605 - Negative pressure wound therapy (e.g., vacuum-assisted drainage collection), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters

  • 97606 - ... total wound(s) surface area greater than 50 square centimeters

    Because CMS will no longer honor its previous 90-day grace period, you'll have to start using the new CPT codes on Jan. 1, 2005.

    Remember that the new CPT codes aren't "official" until the AMA publishes them in the Federal Register later this month. Look for more detailed information on what 2005 holds for orthopedic coders in an upcoming issue of Orthopedic Coding Alert.

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