Orthopedic Coding Alert

Plus -- edits take aim at palm and finger excisions

The Correct Coding Initiative (CCI) decided it hadn't added enough X-STOP bundles in January and created a few more, effective April 1. Here's a breakdown of the most recent edits that affect you most.

Stop Reporting Biopsies With 0171T

CCI bundles many small spinal codes surgeons perform concurrently with 0171T (Insertion of posterior spinous process distraction device [including necessary removal of bone or ligament for insertion and imaging guidance], lumbar; single level) into this lumbar code, which relates to placing the new X-STOP (or similar) device "for decompressing spinal stenosis posteriorly through a very small incision," says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.

These are nonmutually exclusive edits, which are also known as column 1/column 2 or comprehensive/component edits.

What this means for you: According to the version 14.1 edits, you shouldn't report biopsy codes 20220-20251 with 0171T. If you do, payers following CCI guidelines will deny the biopsy codes.

Under the latest edits, payers will also deny 22102 (Partial excision of posterior vertebral component [e.g., spinous process, lamina or facet] for intrinsic bony lesion, single vertebral segment; lumbar) and 22214 (Osteotomy of spine, posterior or posterolateral approach, one vertebral segment; lumbar) if you report either with lumbar code 0171T.

Tip: All of the 0171T edits have a "1" modifier indicator. This means that you may override them with a modifier under appropriate circumstances, such as performing a distinct procedure, says Vicky V. O-Neil, MHA, CPC, CCS-P, owner of St. Louis, Mo.-based consulting firm The Hazlett Group, in The Coding Institute audioconference "Modifiers 25 and 59: Best Practices That Keep Your Claims in the Clear" (available at http://www.audioeducator.com).

Note: Code 0171T became effective Jan. 1, 2007,-but the CPT manual didn't include it until the 2008 version. These edits add to a larger group of 0171T bundles that went into effect Jan. 1, 2008.

Choose 26180 Over 26170

In this round of edits, you should also pay attention to the codes for tendon excision in the finger and palm, Mallon says.

Coders had been misusing tendon excision code 26170 (Excision of tendon, palm, flexor or extensor, each tendon) with 26180 (Excision of tendon, finger, flexor or extensor, each tendon), according to CCI 14.1. Result: The latest version bundles 26170 into 26180.

What this means for you: You only excise the tendon once, Mallon says, so you should only code it once. Report the correct code based on the surgery's anatomic location, either finger (26180) or palm (26170), he says.

Tip: This edit has a "1" modifier indicator, so you may override the edit under appropriate circumstances.

Example: If the surgeon performs a palm tendon excision on the right hand and a finger tendon excision on the left hand, you may report 26170-RT (Right side) and 26180-LT (Left side). You should also append modifier 59 (Distinct procedural service) to 26170, unless your payer instructs you otherwise.