Orthopedic Coding Alert

CPT 2008 is the orthopedic coder's friend this year, with dozens of new codes to make your fracture care and surgical coding a lot easier.

"I am excited about the number of additions to the orthopedic codes for next year," says Shelly Ghrist, CPC, coder at Wolf Creek Medical Associates in Grove City, Pa. "I-m also glad that there aren't a lot of deletions."

Indeed, CPT didn't include many code deletions for orthopedic surgeons, which means you-ll have more codes than ever before to choose from when you-re reviewing your coding choices.

Several coders we spoke to were delighted to see the following new femur fracture codes:

- 27267 -- Closed treatment of femoral fracture, proximal end, head; without manipulation

- 27268 -- ... with manipulation

- 27269 -- Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performed.

"The femoral fracture code additions are good news for orthopedic coders," says Heather Corcoran, coding manager at CGH Billing in Louisville, Ky. "Coders have been looking for a way to code treatment to the proximal end of the femoral head."

Ankle fractures: You already have codes covering treatment of medial malleolus (27760-27766) and lateral malleolus (27786-27792) fractures, and now you-ll be able to code for posterior fractures as well, with these three new codes:

This series should improve coding accuracy for orthopedic offices, particularly those with foot and ankle specialists on board. "I was just looking the other day for a code for a posterior malleolus fracture," Ghrist says.

Big change: You-ll note that CPT has revised the descriptors of more than 50 fracture care codes. In the past, most of these codes included the phrase "with or without internal or external fixation." Now, instead they contain the phrase "includes internal fixation, when performed." This change will make it easier to separately code external fixation if the physician performs it, says Leslie Follebout, CPC-ORTHO, coding department supervisor at Peninsula Orthopaedic Associates in Salisbury, Md.

CPT also brings positivity with the addition of 27416 (Osteochondral autograft[s], knee, open [e.g., mosaicplasty] [includes harvesting of autograft[s]). "I love the much-needed mosaicplasty code," Follebout says. "One of my surgeons does that procedure all the time."

You-ll also benefit from new code 28446 (Open osteochondral autograft, talus [includes obtaining graft[s]), which describes "open osteochondral autograft, talus."

Another new code covers the repair of a fibula non-union and/or malunion with internal fixation (27726).

Spine coders will rejoice over the following three new osteotomy codes:

A parenthetical reference accompanying the codes in CPT specifies that you-ll use these codes for "pedicle/vertebral body subtraction" -- which surgeons may also refer to as "transpedicular three-column osteotomy." Previously, CPT did not contain a code to describe these procedures.

Three new codes cover tenotomy of the lateral or medial elbow for epicondylitis, tennis elbow, or golfer's elbow, as follows:

- 24357 -- Tenotomy, elbow, lateral or medial (e.g., epicondylitis, tennis elbow, golfer's elbow); percutaneous

- 24358 -- ... debridement, soft tissue and/or bone, open

- 24359 -- ... debridement, soft tissue and/or bone, open with tendon repair or reattachment.

CPT 2008 will delete the previous codes for epicondylitis treatment (24350-24356).

"Tennis and golfer's elbow procedures are quite common in orthopedic practices," Corcoran says. "So these codes are going to help a lot of physicians who perform upper-extremity surgeries."

Another new code, 29828 (Arthroscopy, shoulder, surgical; biceps tenodesis), covers arthroscopy of the shoulder in the biceps tenodesis region. This code will be "a hot one," says Angela Bowen, who performs coding and appeals at Strand Orthopaedic Consultants in Myrtle Beach, S.C. Previously, practices reported the unlisted-procedure code (29999) for this service.

Four new codes cover surgical arthroscopy of the subtalar joint:

- 29904 -- Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign body

- 29905 -- - with synovectomy

- 29906 -- - with debridement

- 29907 -- - with subtalar arthrodesis.

Previously, CPT did not include a code for subtalar joint arthroscopy, so coders were pleased to find specificity with the four new codes. In the past, insurers varied on how to report this procedure, with recommendations ranging from the ankle arthroscopy codes (such as 29895) to the unlisted-procedure code (29999).

And this year, you-ll get three new codes to report when your physician uses computer-assisted surgical navigation, as follows:

- +20985 -- Computer-assisted surgical navigational procedure for musculoskeletal procedures; image-less (list separately in addition to code for primary procedure)

- +20986 -- Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on intraoperatively obtained images (e.g., fluoroscopy, ultrasound) (list separately in addition to code for primary procedure).

- +20987 -- Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on preoperative images (list separately in addition to code for primary procedure).

These new Category I codes replace the codes you-ve been using (0054T-0056T). The Category III codes have been deleted effective Dec. 31, 2007.