Orthopedic Coding Alert

Still trying to digest all the Correct Coding Initiative (CCI) version 14.0 changes? This quiz will help you determine whether you-re on the right track or need to take another look at the edits, which went into effect Jan. 1.

Question 1. Your orthopedic surgeon performs closed treatment for an acetabular fracture with manipulation. She also performs closed treatment for a femoral fracture (proximal end, neck) without manipulation on the same patient on the same side of the body. Which of the following should you report?

A. 27222, 27230

B. 27222

C. 27230

Question 2. CPT 2008 changed code descriptors to allow you to report external fixation separately for open treatment codes such as 25515 (Open treatment of radial shaft fracture, includes internal fixation, when performed).

True or False: CCI continues to bundle 20690 (Application of a uniplane [pins or wires in one plane], unilateral, external fixation system) and 20692 (Application of a multiplane [pins or wires in more than one plane], unilateral, external fixation system [e.g., Ilizarov, Monticelli type]) into all of these revised open fixation codes (including 25515).

Question 3: You got three new femoral fracture codes in 2008:

- 27267 -- Closed treatment of femoral fracture,

- 27268 -- ... with manipulation

- 27269 -- Open treatment of femoral fracture,

performed.

Which of the following statements is true?

A. CCI bundles 27267 into 27268

B. CCI bundles 27267 and 27268 into 27269

C. A and B

Check yourself: Check page 58 to see if you-ve got a handle on the latest round of CCI edits.

Are you a CCI 14.0 whiz? Find out below.

Answer 1. B. CCI 14.0 bundles 27230 (Closed treatment of femoral fracture, proximal end, neck; without manipulation) into 27222 (Closed treatment of acetabulum [hip socket] fracture[s]; with manipulation, with or without skeletal traction).

This edit has a modifier indicator of "1." That means you can override the edit with a modifier when appropriate, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.

For example, if the patient has a left femoral fracture and a right acetabular fracture, you could report 27230-LT (Left side) and 27222-RT (Right side).

Answer 2: False. CCI 14.0 deletes the edits that bundled external fixation codes 20690 and 20692 into multiple open reduction codes. For a chart, see Orthopedic Coding Alert, Vol. 11, No. 4.

Answer 3: C. You may have been excited to get these femoral fracture codes, says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky. But like many new codes, 27267-27269 are subject to plenty of edits.

As always, if the surgeon attempts treatment both without and with manipulation, you should report only the "with" code, such as 27268.

And if the surgeon attempts a closed procedure and then decides to perform an open procedure, you should report only the open code, such as 27269.

Tip: Be sure your software is up to date with the latest codes. Or if you want to see the edits in spreadsheet form, head to http://www.cms.hhs.gov/NationalCorrectCodInitEd/.