CPT 2001:
Understand Significant 2001 Orthopedic Coding Changes for Proper Reimbursement
Published on Fri Dec 01, 2000
The American Medical Association (AMA) released CPT changes for 2001 in November 2000. Although the code changes do not take effect until Jan. 1, 2001, orthopedic coders are encouraged to prepare for them now to facilitate a smooth transition after the beginning of the year.
The new codes accomplish several things, explains Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopedic Associates in New Brunswick, N.J., an 11-physician practice representing various orthopedic specialties. In a few cases, they eliminate the need to use unlisted codes, and they create specific codes for procedures that otherwise would have been lumped in with other procedures and articulated by using modifier -22 [unusual procedural services]. According to Stout, the new codes, while few, are beneficial to orthopedists.
Musculoskeletal Codes
CPT introduced a new group of codes into the spine section of the musculoskeletal category. Titled Vertebral Body, Embolization or Injection, the section contains three new codes for percutaneous vertebroplasty.
22520 percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic;
22521 percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; lumbar; and
22522 percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure).
This new section benefits orthopedic spine surgeons in two ways. Prior to the creation of these codes, surgeons had to assign 22899 (unlisted procedure, spine) to the vertebroplasty and include thorough documentation describing the procedure(s) performed. Not only do the new codes address this lack of specificity, they also designate between thoracic and lumbar procedures. As a result, if a surgeon performs a vertebroplasty to both the lumbar and thoracic regions, or to multiple additional vertebral bodies in either of those regions, he or she can use different, multiple codes to describe the procedure. For example, a vertebroplasty to the lumbar region and two thoracic vertebroplasties, all performed within the same surgical session, are coded as follows per CPT 2000:
22899 for the lumbar vertebroplasty;
22899-51 for the first thoracic vertebroplasty, with a multiple procedures modifier; and
22899-51 for the second thoracic vertebroplasty, also with the multiple procedures modifier.
Using CPT 2001 and the new codes, the session would be coded as follows:
22521 for the lumbar vertebroplasty;
22520-51 for the first thoracic vertebroplasty, multiple procedures; and
22522 for the second thoracic vertebroplasty.
Although coders can still anticipate a significant reduction in fees for the secondary procedure (usually 50 percent), these new codes ensure that fewer red flags will be raised as might be with multiple use of the unlisted code. Also note that increasingly, many payers will automatically reduce payment on any codes subsequent to [...]
