Orthopedic Coding Alert

Medicare also bundles operating microscope into more codes than before The latest version of the National Correct Coding Initiative (NCCI) perpetuates the trend of bundling fracture care into more comprehensive procedures - and this time, percutaneous vertebroplasty is under scrutiny.
 
The NCCI version 10.0, effective from Jan. 1 through March 31, bundles the closed fracture treatment codes 22305-22315 and the biopsy codes 20220 and 20225 into both 22520 (Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; thoracic) and 22521 (... lumbar).
 
You can use a modifier to receive separate payment for 22305 (Closed treatment of vertebral process fracture[s]), 20220 (Biopsy, bone, trocar, or needle; superficial [e.g., ilium, sternum, spinous process, ribs]) or 20225 (... deep [e.g., vertebral body, femur]) from the vertebroplasty services if the physician deems both medically necessary and separately identifiable. But 22310 (Closed treatment of vertebral body fracture[s], without manipulation, requiring and including casting or bracing) and 22315 (Closed treatment of vertebral fracture[s] and/or dislocation[s] requiring casting or bracing, with and including casting and/or bracing, with or without anesthesia, by manipulation or traction) carry "0" indicators, which means that no modifier can separate these services from the vertebroplasty codes.
 
"We weren't really expecting these new edits, but they won't be that significant to the orthopedic practices here," says Heather Corcoran, coding manager at CGH Billing Services, a medical billing firm in Louisville, Ky. "Usually the physician will report either fracture care or vertebroplasty, but not both."
 
Operating Microscope Faces More Bundles NCCI 10.0 perpetuates the trend of bundling +69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]) into more comprehensive procedures. NCCI now bundles 69990 into the following codes:
 
20982 - Ablation, bone tumor(s) (e.g., osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance
  21685 - Hyoid myotomy and suspension
  22532 - Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic
  22533 - ... lumbar. The NCCI assigns these edits a "0" indicator, so no modifier can separate the services. "We rarely bill the operative microscope to Medicare, since 69990 usually bundles into other procedures," says Malea Ivey, RHIT, coder at the Orthopedic and Neurosurgical Center of the Cascades in Bend, Ore. "For other carriers, I do bill the operative microscope, as CPT only bundles it with certain codes." (CPT lists these codes in the notes preceding 69990's code descriptor.)

 "For any other non-Medicare payer with any other code combination, we would bill the operative microscope as long as it's properly documented in the body of the operative report. If other insurers follow Medicare rules,
our charges for these services will be denied," Ivey says.

The NCCI still allows you to report 69990 with several spine codes, [...]