Orthopedic Coding Alert

CPT 2002 includes several new musculoskeletal codes that the Correct Coding Initiative (CCI) has yet to address, especially with regard to the appropriateness of bundling some of these procedures. Although many billers rely on CCI's quarterly edits for the most current Medicare bundling guidance, non-Medicare carriers can bundle according to any guidance that professional societies and associations offer. The American Academy of Orthopaedic Surgeons (AAOS) recently published Global Service Data 2002, a guide that physicians and coders will find useful particularly in the absence of any CCI edits on the use of new musculoskeletal codes appearing in CPT 2002. Global Service Data 2002 lists every surgical code from the Musculoskeletal section of CPT, as well as the services included in each code's global package. The guide also includes bundling rules for these codes. Note: CCI did not include edits on the use of new musculoskeletal codes in its latest version (CCI version 8.1, effective April 1-June 30, 2002); thus, the earliest date that CCI could implement any edits involving these codes is July 2002. Although carriers are not required to adhere to AAOS bundling principles, the policies of several carriers follow large portions of the bundles. Besides CMS, the AAOS is what I use for appeals for many bundling issues," says Christie Beach, CPC, of Comprehensive Orthopedics in Kenosha, Wis. "The guide is backed by orthopedic physicians who understand the full scope of procedures and what is really incidental and what is not."

The AAOS guide not only provides authoritative direction as to what procedures should and should not be billed separately but also may serve, at least in part, as the basis for any future CCI edits to codes covering these procedures. And while non-Medicare carriers have the option of following CCI and/or AAOS edits, the AAOS sets the standard for reasonable inclusions and exclusions of these new codes.

"Each carrier has its own proprietary bundling policies, code edits, etc.," says Heidi Stout, CPC, CCS-P, coding and reimbursement specialist at University Orthopaedic Associates in New Brunswick, N.J. "Global Service Data 2002 is an important tool in determining how to correctly report surgeries that may involve multiple CPT codes and gives you compelling backup in instances when the carrier inappropriately rebundles codes." Shoulder Codes Shoulder arthroscopy codes 29806, 29807 and 29824 were a welcome addition to CPT 2002. Prior to the creation of these codes, orthopedists often resorted to unlisted-procedure codes when billing shoulder arthro-scopies. Cumbersome documentation usually included a KISS letter, an operative report and an analogous code, with an explanation of the analogous code's relationship to the procedure performed.

While the addition of three new shoulder arthroscopy [...]