Orthopedic Coding Alert

Watch out: Not all these new edits allow you to unbundle them with a modifier.

Although Correct Coding Initiative (CCI) version 15.0 applies a bevy of edits to orthopedic codes, you shouldn't feel overwhelmed. This simple action plan will steer your orthopedic practice clear of Medicare payback requests for fixation, fasciotomy, and aspiration services.

First off, your new multiplane external fixation codes (20696, Application of multiplane [pins or wires in more than one plane], unilateral, external fixation with stereotactic computer-assisted adjustment [e.g.,spatial frame], including imaging; initial and subsequent alignment[s], assessment[s], and computation[s] of adjustment schedule[s]; and 20697 (... exchange [i.e., removal and replacement] of strut, each) did not escape CCI 15.0's notice.

Codes 20696 and 20697 include dozens of edits, including many x-ray, CT, and MRI codes. Also, these two new codes will now include:

- epidural injections (62318-62319)

- nerve blocks (64415-64417, 64450, 64470, 64475)

- injection/infusion (96360, 96365, 96372, 96374-96375).

All these edits are effective Jan. 1 and carry a modifier indicator of "1," which means you can override them with a modifier (such as 59, Distinct procedural service) if you meet the criteria.

These edits, however, shouldn't be too big of a surprise. "This is to be expected," says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.

If your practice deals with trauma medicine and your physician performs buttock fasciotomies, you should be aware of the following new edits.

Codes 27027-(Decompression fasciotomy[ies], pelvic [buttock] compartment[s] [e.g., gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle], unilateral) and 27057-(Decompression fasciotomy[ies], pelvic [buttock] compartment[s] [e.g., gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle] with debridement of nonviable muscle, unilateral]) now include codes for:

- debridement (11010-11012, 11040-11044)

- hip incision (27000, 27005, 27006)

- nerve block (64415-64417, 64450, 64470, 64475)

- hip x-ray (73530)

- IV infusion (96360, 96365, 96372, 96374-96375).

Translation: Code 27027's descriptor does not mention "with debridement" as 27057 does. You won-t, however, report the debridement separate from 27027. In other words, if you report 27027 with a debridement code (such as, 11010, Debridement including removal of foreign material associated with open fracture[s] and/or dislocation[s]; skin and subcutaneous tissues), your Medicare payer (or other payer who follows CCI edits) will only reimburse 27027.

All these codes carry a modifier indicator of "1."

Rationale: "This is just to warn coders not to include debridement procedures when the MD is doing the fasciotomy," Mallon says.

No reason will suffice to separate the edits attached to new codes 64455 (Injection[s], anesthetic agent and/or steroid, plantar common digital nerve[s] [e.g., Morton's neuroma]) and 64632 (Destruction by neurolytic agent; plantar common digital nerve).

These two codes now include the work represented by:

- microsurgery code +69990 (Microsurgical techniques, requiring use of operating microscope [List separately in addition to code for primary procedure])

- muscle and nerve test codes 95860-95861, 95867-95868, 95870, 95900, 95904, 95920, 95925-95930, 95933-95934, 95936-95937.

Because these edits carry a modifier indicator of "0," you cannot unbundle them for any reason.

CPT 2009 added a code specific to percutaneous diagnostic disc aspiration.

2008 method: For 2008 services, physicians report this service with 10022 (Fine needle aspiration; with imaging guidance), says coding expert Jackie Miller, CCS-P, CPC, vice president of product development for Coding Metrix in Powder Springs, Ga.

2009 method: For services on Jan. 1, 2009, or later, you instead should report new code 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes), Miller says.

An explanatory note with this new code instructs you to look to 77003 (Fluoroscopic guidance and localization of needle or catheter tip -) and 77012 (Computed tomography guidance -) for imaging.

Potential mistake: A note with 77003 states a number of codes, including 62267, include "injection of contrast during fluoroscopic guidance and localization." This note means the listed codes include the contrast injection -- not the fluoro guidance and localization. You may report 62267 and 77003 together.

This new code now includes:

- Modifier indicator of "0": anesthesia codes (01935-01936), microsurgery code (+69990)

- Modifier indicator of "1": discography (62291), epidural codes (62311, 62318-62319), nerve block codes (64415-64417, 64450, 64470, 64475, 64479, 64483), fluoroscopy codes (76000-76001), and the renumbered injection/infusion codes (96360, 96365, 96372, 96374-96375).

Bonus: The last edits listed (the renumbered injection/infusion codes) are also a part of nail debridement (11719-11765), intralesional injection (11900-11901), drug delivery implant (11981-11983), and wound repair procedures (13100-13160). You can separate these edits with a modifier if necessary.

CCI 15.0 responds to renumbered infusion and injection codes (96360, 96365, 96372, 96374, and 96375) by bundling these codes into all observation, hospital, emergency department, inpatient consultation, and critical care E/M services.

"These are not new edits per se, as the old codes representing these services were bundled in previous CCI versions," says Melanie Witt, RN, COBGC, MA, a coding expert based in Guadalupita, N.M.-They carry an indicator of "1" which means the bundle can be bypassed with the appropriate modifier if the criteria for using than modifier are met (such as modifier 59).