Orthopedic Coding Alert

The updated Current Procedural Terminology (CPT) manual, CPT 2000, published by the American Medical Association, is hot off the presses. Fortunately, it holds only a few changes and additions for orthopedic practices, according to Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant based in North Augusta, SC.

The changes are effective Jan. 1, 2000; insurers that recognize CPT methodology should begin paying under the coding updates at that time. Some insurers and Medicare allow providers a grace period until April 1, 2000 to begin using the new codes.

New to the CPT lexicon are codes involving an injection procedure, and complex reconstructive and wound closure surgeries. Code 27096injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroidis the first that addresses injections to that particular joint, Callaway-Stradley reports. The code description includes the following guideline for coding the radiology services associated with this procedure: For radiological supervision and interpretation, use 73542. If formal arthrography is not performed, recorded, and a formal radiologic report is not issued, use 76005 for fluoroscopic guidance for sacroiliac joint injections.

Also new, in the Repair (Closure) subsection, are codes 13102, 13122, 13133 and 13153. Collectively, they replace code 13300, which has been deleted. The old code covered any complex repair greater than 7.5 centimeters (cm) on any area of the body, and allowed for billing of only one repair, regardless of the number actually performed. The new codes may facilitate higher reimbursement for the repair of larger wounds, and billing for multiple repairs during the same operation, Callaway-Stradley says.

Code 13102, each additional 5 cm or less (list separately in addition to code for primary procedure), is to be used with 13101, repair, complex, trunk; 2.6 cm to 7.5 cm.

Code 13122, each additional 5 cm or less (list separately in addition to code for primary procedure), is to be used with 13121, repair, complex, scalp, arms and/or legs; 2.6 cm to 7.5 cm.

Code 13133, each additional 5 cm or less (list separately in addition to code for primary procedure), is to be used with 13132, repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm.

Code 13153, each additional 5 cm or less (list separately in addition to code for primary procedure), is to be used with 13152, repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm.

CPT 2000 also includes changes to several existing codes, many of which reflect new surgical techniques and technologies.

Under the Spinal Arthrodesis subsection, code 22630 now reads: arthrodesis, posterior interbody technique, including laminectomy and/or diskectomy to prepare interspace (other than for decompression), single interspace; lumbar, and has an associated add-on code 22632, each additional interspace (list separately in addition to code for primary procedure). The change clarifies that practices cannot bill for laminectomies or diskectomies that are just to prepare the interspace, Callaway-Stradley explains.

Code 22840 in the Spinal Instrumentation subsection now reads: posterior non-segmental instrumentation (eg. Harrington rod technique), pedicle fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation. It provides more examples of the types of fixations used, but do not reflect a change in the meaning or emphasis of the code, according to Callaway-Stradley.

Similarly, the update to 22851 gives a broader list of the types of spinal prosthetic devices used: application of intervertebral biomechanical device(s) (eg. synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace. This change should clarify proper coding for the new spinal prosthetic devices. Previously, for example, many coders who noted that a surgeon used a threaded bone dowel were uncertain which code they should bill under, Callaway-Stradley explains.

With deletion of the word each before prosthetic, the change to code 26416 clarifies that the focus of the procedure is the patients tendon, rather than the prosthetic rod, says Callaway-Stradley. The code, which is in the Hand and Fingers Repair, Revision, and/or Reconstruction subsection, now reads: removal of prosthetic rod and insertion of extensor tendon graft (includes obtaining graft), hand or finger, each tendon.

Changes to code 29879 reflect new arthroscopic techniques available today, according to Stradley. The code now reads: abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture.

One CPT 2000 change involves clarification of vertebral segments and interspaces for proper coding of various spinal procedures such as arthrodesis and instrumentation. In the descriptive language for codes 22548 through 22899, CPT 2000 defines a vertebral segment as the basic constituent part into which the spine may be divided. It represents a single complete vertebral bone with its associated articular processes and laminae. A vertebral interspace, it says, is the non-bony compartment between two adjacent vertebral bodies which contains the intervertebral disk, and includes the nucleus pulposus, annulus fibrosus, and two cartilagenous endplates.