Orthopedic Coding Alert

CPT 2003 introduced three new arthroscopic surgery codes, including 29827 (Arthroscopy, shoulder, surgical; with rotator cuff repair), a welcome change for practices that have long used the unlisted arthroscopy procedure code (29999) for arthroscopic rotator cuff (RTC) repairs.

CPT 2003 unveiled more than 150 new codes, but the following three will be most useful for orthopedic practices:

"We have been waiting for an arthroscopic rotator cuff repair code for a long time," says Billie Jo C. McCrary, CPC, CPC-H, CCS-P, RMC, coding coordinator at Wellington Orthopaedic and Sports Medicine, a Cincinnati practice.

"Using the unlisted-procedure code was time-consuming for the staff," McCrary says, "because we had to send a paper claim with a letter explaining what we did, along with the operative report." To determine a fee to bill with the unlisted-procedure code, McCrary used to compare the arthroscopic RTC repair to 23412 (Repair of ruptured musculotendinous cuff [e.g., rotator cuff]; chronic).

Rotator Cuff Code Lacks Specificity

What CPT doesn't delineate, says Douglas Jorgensen, DO, CPC, president of Jorgensen Consulting LLC, in Manchester, Maine, is whether the new code refers to a full-thickness rotator cuff tear (727.61, Complete rupture of rotator cuff) or whether orthopedists can use it for a partial rotator cuff tear (840.4).

"CPT explicitly stated in 2002 that you have to be as specific as possible or else use an unlisted-procedure code," Jorgensen says, "and this leaves open to interpretation whether someone can use this code if they have, for instance, an acute strain of the supraspinatus muscle (840.6)." This question may be answered in the coming months as the CPT Advisory Panel releases more information about the new codes.

CPT advises coders to use 23412 for open and mini-open RTC repairs, and recommends billing 29826-51 (Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release; -Multiple procedures) along with 29827 when performing arthroscopic subacromial decompression (SAD) with arthroscopic rotator cuff repairs.

Report 29824-51 (Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface [Mumford procedure]) with 29827 for arthroscopic distal clavicle resections with arthroscopic RTC repairs.

New Definition May Mean Fewer RVUs

The new arthroscopic lateral release code (29873) caused a slight ripple effect in CPT. Code 27425, previously defined as "Lateral retinacular release (any method)," is now defined simply as "Lateral retinacular release open."

This new definition may cause a reimbursement cut for the arthroscopic procedure, says Ryan Price, CPC, CCS-P, manager of coding operations at Aviacode, a medical coding and reimbursement consulting firm in Salt Lake City. "Medicare tends to value arthroscopic procedures less than open surgeries, so it's possible that they will assign a lower RVU to the new code."

If Medicare assigns a lower RVU to 29873 than 27425, the new code will actually cause orthopedists to lose money, since they were able to recoup equal reimbursement for both procedures when the "any method" code was the standard.

Note: At press time, CMS had delayed the 2003 Physician Fee Schedule, originally due for release Nov. 1. Orthopedic Coding Alert will report on the new RVUs as soon as CMS releases them.

Ankle Codes Now Specify Method

The new ankle arthroscopy code (29899) also describes an arthroscopic procedure that was formerly reported with the "any method" code 27870. CPT now defines 27870 as "Arthrodesis, ankle, open."

Coders are anxiously awaiting the Physician Fee Schedule for these codes as well to determine whether reimbursement will decrease due to the new code.

CPT also introduced two "Miscellaneous Services" codes. Medicare probably won't reimburse for these codes, but orthopedists don't need to despair:
 

If Medicare denies these codes on the same basis as the after-hours codes (99050-99054), Jorgensen says, "there is a chance that some private insurers may reimburse for them. They may help practices optimize reimbursement."

Note: These code changes and additions are not yet finalized. The AMA CPT Advisory Committee will meet Nov. 14-15 to review the code changes and make its final determination on new codes for 2003.