Orthopedic Coding Alert

Watch for the new compression codes and manipulation.

Certain CPT® 2012 codes that dodged the Correct Coding Initiative (CCI) edit pairs in January are all bundled up as of April 1, 2012. One such edit is for the reporting of certain vascular injections and blood vessel repair. You will need to be watchful when reporting these. You will frequently encounter vessel repairs when your surgeon is treating crush injury, deeper wounds, and some cases of open fracture.

CCI version 18.1 reveals a fairly light update, with 358 new edit pairs and 23 terminated pairs. For new pairs, surgery dominated with over 90 percent of both column 1 and column 2 codes, said Frank D. Cohen, MPA, MBB, senior analyst with The Frank Cohen Group, LLC, in his analysis of the changes.

Avoid 36251 with 35231 and Beyond

CCI 18.1 adds nearly 50 edit pairs with the following blood vessel repair codes in the column 2 position:

• 35231  Repair blood vessel with vein graft; neck
• 35236 -- ... upper extremity
• 35256 -- ... lower extremity
• 35261 -- Repair blood vessel with graft other than vein; neck
• 35266 -- ... upper extremity
• 35286 -- ... lower extremity

Resources: You can perform edit-pair lookups at https://www.aapc.com/codes/ or access the edit table at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/NCCI-Coding-Edits.html

Mix Compression With Manipulation

CPT® 2012 added three new multi-layer compression system codes, and all three (below) are now bundled with 97140 (Manual therapy techniques [e.g., mobilization/manipulation, manual lymphatic drainage, manual traction], 1 or more regions, each 15 minutes):

• 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.

Review your group's use of these code pairs to see if you need to revise your reporting policy, says Todd Thomas, CPC, CCS-P, President of ERcoder, Inc. in Edmond, Okla.

Look for Streamlined Edit Groupings

There's a twist in the way this latest round of edits is organized that could make things easier for you.

That was then: Since 1996, CMS has assigned procedure-to-procedure CCI edits either to the Column One/Column Two Correct Coding edit file or the Mutually Exclusive edit file based on the criterion for each edit, says Thomas. The Mutually Exclusive edit file included edits involving two procedures that could not be performed at the same patient encounter because they were mutually exclusive based on anatomic, temporal, or gender considerations. CMS assigned all other edits to the Column One/Column Two Correct Coding edit file.

This is now: With the April 2012 release, CMS consolidates the two edit files into the Column One/Column Two Correct Coding edit file. CMS carried out the consolidation both for the Physician CCI edit files and the Hospital (also known as the Outpatient Code Editor or OCE) edit files. The change should make it easier for users, because now you'll only have to search the Column One/Column Two edit file for active or previously deleted edits.

Caution: Remember that CMS did not delete the edits previously contained in the Mutually Exclusive edit file, but moved them to the Column One/Column Two Correct Coding edit file.

"The CCI edit process is performed quarterly. Professional medical associations have been given the opportunity to review and comment of these edits," says Gregory Przybylski, MD, director of neurosurgery, New Jersey Neuroscience Institute, JFK Medical Center, Edison. The development of these edits is performed by a subcontractor to CMS.