Orthopedic Coding Alert

You-ll also find new codes for some fluoro procedures

If you-ve been looking for a more precise way to code open treatment of distal radial fractures, CPT 2007 has your solution. Read on to get a sneak peek at some of the new codes that will affect orthopedic practices.

Many of the changes to the musculoskeletal section of CPT include slight revisions to existing descriptors, but several other changes will make a big difference in your coding. First and foremost, CPT has introduced the following four new codes to reflect surgical treatment of distal radial fractures:

- 25606 -- Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation 
                                                            
- 25607 -- Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation  
                                   
- 25608 -- Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments  

- 25609 -- Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments.              

-We are fixing more and more of these, and the internal fixation is getting more complex, with fragment-specific fixation,- says Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C. -Codes 25608-25609 certainly refer to these in which several fragments are internally fixed.-

Nerve Repair Codes Will Help Upper-Extremity Surgeons

CPT adds two codes for nerve repair, which could help hand surgeons report these complex surgeries:

- 64910 -- Nerve repair; with synthetic conduit or vein allograft (e.g., nerve tube), each nerve  

- 64911 -- Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve.

-These codes will be used for the -Sotereanos procedure,- named after Dean Sotereanos, a hand surgeon in Pittsburgh,- Mallon says. -For revision surgery, primarily on the ulnar nerve at the elbow, and also occasionally on the median nerve at the carpal tunnel, he has pioneered a vein-wrapping procedure in which he harvests the saphenous vein and wraps the nerve in that to decrease nerve sensitivity.

-The synthetic conduit refers to the fact that several companies make a synthetic conduit to allow the nerve to be wrapped in that and avoid the necessity of harvesting a vein,- Mallon says.

Replace T Codes With New Spine Surgery Codes

Spine surgeons can say goodbye to category III codes 0090T-0098T for total disk arthroplasty. Starting in January, you-ll have three new codes to report this cutting-edge procedure:

- 22857 -- Total disk arthroplasty (artificial disk), anterior approach, including diskectomy to prepare interspace (other than for decompression), lumbar, single interspace. 
                          
- 22862 -- Revision including replacement of total  disk arthroplasty (artificial disk) anterior approach, lumbar, single interspace

- 22865 -- Removal of total disk arthroplasty (artificical disk), anterior approach, lumbar, single interspace.
 
Coders are pleasantly surprised that CPT replaced the -T- codes so quickly. -It seems fast compared to how long we waited for a kyphoplasty code,- says Denise Paige, CPC, coding and billing manager at Beach Orthopedic Associates in Long Beach, Calif., and the secretary of the AAPC's Long Beach Chapter. 

Remember: Payers maintained very specific guidelines for the T codes, and they will probably apply to the new CPT codes as well. Be sure to get your insurer's guidelines in writing, and submit all required documentation with your claims.

-The radiology codes will also require some added attention this year,- says Susan Vogelberger, CPC, CPC-H, CMBS, CCP, owner and president of Healthcare Consulting & Coding Education LLC in Boardman, Ohio. The new CPT manual will delete fluoroscopic guidance codes 76003 and 76005 but will debut two codes as replacements:

- 77002 -- Fluoroscopic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device) 

- 77003 -- Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural, transforaminal epidural, subarachnoid, paravertebral facet joint, paravertebral facet joint nerve, or sacroiliac joint), including neurolytic agent destruction.

Keep in mind: Just because CPT introduces a new code, you aren't guaranteed reimbursement. Orthopedic Coding Alert will continue to update you on the new code changes and corresponding reimbursement challenges that will affect you in the coming year.