Orthopedic Coding Alert

The new edition of NCCI targets surgical codes With more than 9,000 changes in the latest National Correct Coding Initiative quarterly update (version 13.0, effective Jan. 1), you could spend an entire month trying to determine how the edits will affect your orthopedic surgery practice.

Or you could simply look below for the most important additions and deletions. NCCI Affects New Spine Codes The new edition of NCCI bundles 69 codes into the new percutaneous intradiscal electrothermal annuloplasty codes 22526 (Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level) and +22527 (... one or more additional levels [list separately in addition to code for primary procedure]).

For example, you can no longer bill spinal surgery codes 62270, 62287, 62290-62291, 62310-62319 and discography codes 72285 and 72295 with the new codes in the 22526-22527 range.

But hopefully this shouldn't affect many practices, because you may have expected these bundles. -The discography codes seem to be an integral part of the annuloplasty procedure, so no, this doesn't surprise me,- says Denise Paige, CPC, coding and billing manager at Beach Orthopedic Associates in Long Beach, Calif., and the president-elect of the AAPC's Long Beach Chapter.

Arthroplasty targeted: The NCCI also created over 40 new component codes that will now be bundled into the new total disc arthroplasty codes 22857-22865.

Among the procedure codes that are now bundled into these codes are other arthrodesis codes, spinal instrumentation codes, laparotomy codes, needle electromyography codes, nerve conduction study codes, an intraoperative neurophysiology code (95920), and evoked potentials and reflex test codes (95925-95937).

-This isn't a big surprise, either,- Paige says. -It seems, despite what the vendors say, that most of the intraoperative imaging and sensory tests seem to be bundled and not separately payable.-

As far as the instrumentation being included in the total disc arthroplasty, -it also seems to be the trend to lump everything into one code (the laminoplasty codes are one example), which makes it easier to code, but payment-wise it may not be so beneficial,- Paige says. -But then when you look at the multiple procedure/payment rules that most carriers have, it may end up the same whether it's one code or several.- NCCI Also Targets Radial Fracture, Tendon Codes Practices that were excited to get a new tendon excision code (25109, Excision of tendon, forearm and/or wrist, flexor or extensor, each) may be surprised to see that they can no longer bill debridement codes 11010-11012, elbow manipulation code 24300, tendon surgery codes 25000-25001 and 25110, or wrist manipulation code 25259 with 25109, unless they can justify it with a modifier.

On the bright side, however, -the RVUs for 25109 include the component codes, so the edits are reasonable,- says Susan Vogelberger, [...]