Orthopedic Coding Alert

Amazing: CPT throws 2 regular CPT codes back into Cat. III status.

To obtain picture-perfect orthopedic claims next year, you can't limit your CPT 2009 book search to new codes -- you need to underline and apply these revisions, too.

Our experts break down these subtle details, so you can be certain you-re ready for Jan. 1.

When guidelines and descriptors do not match up, CPT usually revises existing codes. That is the case for intermediate repair codes 12031-12057.

Rationale: CPT guidelines instruct you to use 12031-12057 for the single-layer closure of heavily contaminated wounds, but the 2008 descriptors state "Layer closure of wounds -" In 2009, these codes will say "Repair, intermediate,

 wounds -" (emphasis added). This revision should help you avoid coding mishaps.

If your orthopedic surgeon performs hamstring transfers, you should be aware of a revision. Code 27396 will have a descriptor that states: "Transplant or transfer (with muscle redirection or rerouting), thigh (e.g., extensor to flexor); single

tendon" (emphasis added). In turn, this revision also changes 27397 (- multiple tendons).

Why: "Because 27396 and 27397 were originally written to describe a specific transfer of hamstring(s) to patella, the language -hamstrung- the use of these codes," explained Charles Mick, MD, a Northampton, Mass.-based Pioneer Spine and

Sports physician in "Spine Surgery/Neurosurgery" at the CPT and RBRVS 2009 Annual Symposium in Chicago. The procedure can actually transfer the other way.

When 2009 rolls around, you will strike through the phrase "Aspiration or" when you-re looking at 62287 (Aspiration or decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels,

lumbar [e.g., manual or automated percutaneous discectomy, percutaneous laser discectomy]). This code will only represent the "decompression" of the nucleus pulposus.

Do this: For the aspiration, you should look to new code 62267 (Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes).

A lack of specificity had many coders questioning how to use lumbar and cervical laminotomy codes (63020-63030). Code 63030 includes verbiage that explains "including open and endoscopically-assisted approaches" at the lumbar level but not

at the cervical. Therefore, you-ll find clarification in 2009.

The definitions read as follows (emphasis added):

- 63020 -- Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniat-ed intervertebral disc, including open and endoscopi-cally-assisted

approaches; 1 interspace, cervical

- 63030 -- ... 1 interspace, lumbar.

Finally, codes 20986 (Computer-assisted surgical navigational procedure for musculoskeletal procedures; with image guidance based on intraoperatively obtained images [e.g., fluoroscopy, ultrasound] [List separately in addition to code for

primary procedure]) and 20987 (... with image guidance based on preoperative images [List separately in addition to code for primary procedure]) premiered as regular Category I CPT codes in 2008.

In 2009, you-ll need to put them back into the Category III list -- as 0054T and 0055T. Their definitions remain almost identical to their previous CPT counterparts.