Orthopedic Coding Alert

New edition of NCCI bars you from billing meniscal transplant with debridement
 
If you're billing vertebral body excision with your corpectomy claims, you should expect to collect less reimbursement from Medicare and other payers that follow the NCCI edits. Version 11.1 of NCCI, which went into effect on April 1, bundles these procedures.
 
Read on for the scoop on which codes the NCCI targeted this time around.

NCCI Assigns Edits to Spine Codes

The National Correct Coding Initiative (NCCI) now bundles vertebral body excision into the vertebral body resection codes, as follows:

Medicare carriers will deny payment for 22112 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root[s], single vertebral segment; thoracic) if you report it with 63101 (Vertebral corpectomy [vertebral body resection], partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root[s] [e.g., for tumor or retropulsed bone fragments]; thoracic, single segment).

NCCI also includes edits that apply to the corresponding lumbar codes. Therefore, you'll find that 22114 (Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root[s], single vertebral segment; lumbar) is now a component of 63102 (Vertebral corpectomy [vertebral body resection], partial or complete, lateral extracavitary approach with decompression of spinal cord and/or nerve root[s] [e.g., for tumor or retropulsed bone fragments]; lumbar, single segment).

Modifier Can Separate 22114, 63102, if Warranted

"The edit bundling 22114 into 63102 makes sense because the two procedures are so very close in description," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J. "Code 22112 is reported for partial excision of the vertebral body without decompression, while the corpectomy codes include decompression."

Because these edits include a "1" indicator, you can use a modifier (such as -59, Distinct procedural service) to unbundle the codes in the rare case that the surgeon performs them separately from one another (for example, on separate vertebral segments).

New Meniscal Transplant Code Takes a Hit

Although the previous version of NCCI (11.0) included hundreds of edits aimed at codes that CPT introduced in 2005, the new version includes one more new code edit for orthopedic coders.

When your surgeon performs a meniscal transplantation, you should report the new code 29868 (Arthroscopy, knee, surgical; meniscal transplantation [includes arthrotomy for meniscal insertion], medial or lateral). But don't expect to report 29877 (Arthroscopy, knee, surgical; debridement/shaving of articular cartilage [chondroplasty]) with it.

NCCI 11.1 will deny 29877 if you report it with 29868, and no modifiers can separate the edit. "Although the parenthetical note in CPT didn't say that coders couldn't bill chondroplasty with the meniscal transplant code, CPT Changes 2005 did imply that chondroplasty is included," says Kendra Sykes, office manager at Orthopaedic Associates in Dallas.

Rationale: According to CPT Changes 2005, 29868 describes meniscal transplantation that includes "preparation of the defect area with removal of the damaged portion of the meniscus."

"Our practice took this to mean that the standard 'cleaning up' of the cartilage is included in 29868," Sykes says. "Therefore, it makes sense that you can't report 29877 with 29868."

NCCI Takes Aim at Arthrodesis

You'll want to check the new version of NCCI with a fine-toothed comb if you perform arthrodesis, because NCCI bundles 11 additional codes into both 22532 (Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace [other than for decompression]; thoracic) and 22533 (... lumbar).

You can separate the edits with a modifier if the surgeon performs separate and distinct services, but if he does not, you should avoid reporting the following codes with 22532 and 22533: