Orthopedic Coding Alert

Version 8.2 of the national Correct Coding Initiative (CCI) took effect on July 1 and bundles several anesthesia and trigger point injection codes into many of the musculoskeletal surgical procedures frequently billed by orthopedists.

Most revisions in CCI 8.2 involve bundling anesthesia procedures (00100-01999) to most orthopedic surgical codes. For example, the femur and knee joint surgery codes 27301-27357 and 27360-27598 now include anesthesia codes 01250, 01320 and 01995. Other surgical codes are paired with various combinations of anesthesia codes. For instance, 25651 (Percutaneous skeletal fixation of ulnar styloid fracture) now includes 01810, 01820 and 01995, whereas 25652 (Open treatment of ulnar styloid fracture) includes only 01810 and 01820. Review version 8.2 carefully to pinpoint which codes in your practice now include anesthesia procedures.

Even the frequently billed arthrocentesis codes 20600-20610 were affected by the change. CCI now bundles 00400 (Anesthesia for procedures on the integumentary system on the extremities, anterior trunk and perineum; not otherwise specified) into them.

CCI is finally catching up with the new injection codes (20526, 20551-20553) that were introduced in CPT2002 and bundles these codes into both 20550* (Injection; tendon sheath, ligament, ganglion cyst) and the joint injection codes (20600-20610). If the trigger point injection and joint injection were performed on the same date" but for separate sites or conditions the practice could append modifier -59 (Distinct procedural service) to the second procedure and bill both codes together " saysHeidi Stout CPC CCS-P coding and reimbursement manager at University Orthopaedic Associates in New Brunswick N.J.

Codes from the injection series 20526-20553 are also included in many of the musculoskeletal surgery codes ranging from 20802 through 28825. For instance 20551-20553 are included in hand and finger surgery codes 26010-26117 while 20526 (Injection therapeutic [e.g. local anesthetic; corticosteroid] carpal tunnel) is included in the add-on hand and finger code +26125 (Fasciectomy partial palmar with release of single digit including proximal interphalangeal joint with or without Z-plasty other a way. local tissue rearrangement or skin grafting [includes obtaining graft]; each additional digit). Again these changes affect scores of codes so be sure to review this section of CCI 8.2 carefully.

The new injection codes 20551-20553 now include codes 76000 (Fluoroscopy [separate procedure] up to one hour physician time other than 71023 or 71034 [e.g. cardiac fluoroscopy]) and 90782 (Therapeutic prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular).

Predictably the bone cartilage tendon fascia and tissue graft codes 20900-20926 are now included in their corresponding surgery codes that indicate "includes obtaining graft." For instance 24802 (Arthrodesis elbow joint; with autogenous graft [includes obtaining graft]) now includes codes 20900-20902 while 26541 (Reconstruction collateral ligament metacarpopha-langeal joint single; with tendon or fascial graft [includes obtaining graft]) now includes 20920-20926.

All of the skin graft codes 14000-15776 except for the add-on codes in that range are now components of the fasciectomy codes 26121-26123.

Fluoroscopic guidance code 76003 (Fluoroscopic guidance for needle placement [e.g. biopsy aspiration injection localization device]) is now bundled into codes 23350 24220 25246 and 27648 while 76000 is bundled into 25651 25652 and 25671.

Debridement codes 11010-11044 are now bundled into surgery codes 25024 25394 and 25431 while 11040-11044 are bundled only into 25020 (Decompression fasciotomy forearm and/or wrist; flexor OR extensor compartment; without debridement of nonviable muscle and/or nerve). In addition 11040-11042 are included in 25023 (Decompression fasciotomy forearm and/or wrist flexor OR extensor compartment; with debridement of nonviable muscle and/or nerve) while 11010 and 11040-11042 are included in 25025 (Decompression fasciotomy forearm and/or wrist flexor AND extensor compartment; with debridement of nonviable muscle and/or nerve).

The introduction of shoulder arthroscopy codes 29805-29807 and 29824 affects the CCI edits for several shoulder procedures. Shoulder joint manipulation code 23700 is included in 29806 29807 and 29824 while 29806 (Arthroscopy shoulder surgical; capsulorrhaphy) is a component of arthroscopy codes 29819-29823 and 29825-29826.

The new wrist manipulation code 25259 is now included in wrist surgery codes 25031-25251 25260-25274 25280-25393 25400-25426 25440-25650 25660-25670 and 25675-25931 and is also included in the wrist arthroscopy codes 29840-29848.

Similarly the new elbow manipulation code 24300 is a component of elbow arthroscopy codes 29834-29838; and the new finger manipulation code 26340 is included in the new arthroscopy codes 29900-29902.

Code 64450* (Injection anesthetic agent; other peripheral nerve or branch) has now been bundled to codes 11981-11983 which describe the implantation removal and reinsertion of nonbiodegradable drug-delivery implants.

The main deletion in CCI 8.2 relevant to orthopedists is the fact that metatarsal osteotomy codes 28296 and 28299 are no longer bundled. Other codes listed as deletions include no-longer-viable codes such as 29815 and 26585 but these changes should have no effect if you are using an up-to-date version of CPT.