Orthopedic Coding Alert

The Correct Coding Initiative (CCI) version 7.2, which went into effect on July 1, 2001, contains many changes to the codes for the musculoskeletal system -- codes that have the most impact on orthopedics -- but the  effect of these changes should be small.
 
The CCI was introduced by HCFA (now CMS; see story on page 61) to identify codes that are bundled together and therefore not normally reported separately. The edits are updated quarterly and range from the minor to the major in their effects on coding and billing.
 
The "mutually exclusive" edits list procedures that can never be performed at the same operative setting.  The "comprehensive codes" are the major procedure, and  several other less involved, or "component," procedures are bundled with them.
 
Several comprehensive codes received additional component, or bundled, codes:

Code 22612 (arthrodesis, posterior or posterolateral technique, single level; lumbar [with or without lateral transverse technique]) now includes 49002 (reopening of recent laparotomy), lumbar/sacral injection codes 62311 and 62319, and 64483 (injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar, sacral, single level).
 

Code 22840 (posterior non-segmental instrumentation [e.g., Harrington rod technique], pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) had the following added as component codes: cervical or thoracic injection codes 62310 and 62318, and 64479 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level).
 

Code 22851 (application of intervertebral biomechanical device[s] [e.g., synthetic cage(s), threaded bone dowel(s), methylmethacrylate] to vertebral defect or interspace) saw the addition of the laparotomy codes 49000-49002 and the spinal injection codes 62310-62319, 64479 (injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level) and 64483 (... lumbar or sacral, single level).

 
With many of the fracture care codes, 97601 (removal of devitalized tissue from wound; without anesthesia) was bundled, along with HCPCS code G0168 (wound closure using tissue adhesive[s] only).
 
Note: Although this article indicates some of the biggest  changes in CCI 7.2 for orthopedics, it is not a substitute for the complete list of changes.