Orthopedic Coding Alert

If your practice provides neurostimulion services, note these changes.

CCI 18.0, effective Jan.1, brings important changes that could affect your coding for some selected orthopedic services. Our experts advise you on what's critical in the latest round.

Look for Neurostimultors and Epiphyseal Bar Excision Adjustments

As of Jan. 1, 2012, you can report neurostimulator electrode array placement, pulse generator implantation, and revision or removal of these along with epiphyseal bar excision code 20150 (Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incision).

"Pediatric orthopedicians may have the rare chance of using these codes," says Bill Mallon, MD, medical director, Triangle Orthopedic Associates, Durham, N.C. "Removal of an epiphyseal bar is performed for growth disturbances in long bones due to premature fusion of a portion of the growth plate. This can occur due to trauma or infection that causes the fusion of the epiphysis to the metaphysis. In the unusual circumstance that the neurostimulator electrodes and generator are applied for postoperative pain control, NCCI guidelines would likely bundle the procedure. Were the electrodes implanted for an unrelated diagnosis, such as chronic low back pain, the 59 modifier would apply," says Kristi Stumpf, MCS-P, CPC, COSC, ACS-OR, owner, Precision Auditing and Coding, senior orthopedic coder & auditor, The Coding Network, Washington.

Note that 20150 is the column 1 code in this edit. The following codes are the column 2 codes according to CCI 18.0:

• 0282T -- Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; for trial. Including removal at the conclusion of trial period
• 0283T -- Percutaneous or open implantation of neurostimulator electrode array(s), subcutaneous (peripheral subcutaneous field stimulation), including imaging guidance, when performed, cervical, thoracic or lumbar; permanent, with implantation of a pulse generator
• 0284T -- Revision or removal of pulse generator or electrodes, including imaging guidance, when performed, including addition of new electrodes, when performed

When you have a patient with multiple comorbidities being treated for an epiphyseal bar, you can report multi-layer compression with modifier 59 (Distinct procedural service). "Once again, if applied for an unrelated diagnosis or separate site application, the application of the multi-layer compression system would be separately reported. The key for use of the 59 modifier would be for separate site or separate pathology application of the multi-layer compression system. This may occur in multi-trauma situations, or for patients with multiple presenting comorbidities such as chronic venous stasis or lymphedema with treatment of an epiphyseal bar," says Stumpf.

Adjust Multi-layer Compression Coding

You report the application of multi-layer compression with 20150. Here again, 20150 is a column 1 code. You report the following column 2 codes, with appropriate modifier, if these are done in the same session and if adequate documentation supports the same.

• 29582 -- Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed
• 29583 -- Application of multi-layer compression system; upper arm and forearm
• 29584 -- Application of multi-layer compression system; upper arm, forearm, hand, and fingers

Apply These Foreign Body Removal in Muscle or Tendon Edits

You may report 20527 (Injection, enzyme [eg, collagenase], palmar fascial cord [ie, Dupuytren's contracture]) with 20520 (Removal of foreign body in muscle or tendon sheath; simple).

CCI places 20527 in column 2 and 20520 in column 1. Code 20527 is also a column 2 code with 20525 (Removal of foreign body in muscle or tendon sheath; deep or complicated) in CCI 18.0. "The edit would be over-ridden in this situation if the injection procedure was a separate site procedure and unrelated to the palmar fascial injections. An example would be foreign body removal from a muscle or tendon sheath in the foot with injection in the palmar fascia of the hand. Same site injections are bundled per NCCI guidelines and CCI edits to the global service package," says Stumpf.

Don't Overlook Edits in Injections and Compression in Upper Limb

When reporting injections as therapy for carpal tunnel syndrome, you may use the application of multi-layer compression in the upper limb under special circumstances. For this, code 20526 (Injection, therapeutic [eg, local anesthetic, corticosteroid], carpal tunnel) is a column 1 code and code 29584 (Application of multi-layer compression system; upper arm, forearm, hand, and fingers) is a column 2 code according to CCI 18.0.

"In this circumstance, the multi-layer compression dressing would need to be applied for an unrelated or separate injury or pathology. For instance, if the patient suffered from lymphedema of the upper extremity and also suffered from carpal tunnel, if the injection were being given for treatment of the carpal tunnel and the multilayer compression dressing applied for a diagnosis of lymphedema, the procedures would be separately reportable," says Stumpf.