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. New Injection Codes Included in Most Surgeries 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). Skin Grafting Included With Fasciectomy 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 [...]