Orthopedic Coding Alert
NCCI Rings In 2005 With Hundreds of Edits Affecting New Codes
The grinch comes late this year, as wound care, knee surgery bundles abound If you're just starting to break out the new 2005 CPT codes, beware of the latest NCCI edits, which bundle scores of new codes with existing musculoskeletal codes. The new edits, which went into effect on Jan. 1, bundle wound care into hundreds of orthopedic codes, and solidify edits for new knee surgery codes. Medicare Bundles Wound Care Into Surgery CPT 2005 includes two new codes for active wound care based on the wound's size, as follows: Now the National Correct Coding Initiative (NCCI) makes these two codes components of a startling 540 codes, including 434 musculoskeletal surgery codes such as 20802 (Replantation, arm [includes surgical neck of humerus through elbow joint], complete amputation) and 23630 (Open treatment of greater humeral tuberosity fracture, with or without internal or external fixation), as well as neuroplasty codes 64702-64726. NCCI Bundles Procedures Into Wound Care In addition, 280 codes will now be bundled into both 97597 and 97598, including nerve block injection/introduction codes 64400-64483, operating microscope code 69990 (Microsurgical techniques, requiring use of operating microscope [list separately in addition to code for primary procedure]), intralesional injection codes 11900-11901, and the physical therapy re-evaluation code 97002. NCCI Doesn't Overlook New Knee Codes The new version of NCCI also bundles knee surgery codes 29870-29871, 29874-29875 and 29880-29884 into the following new knee grafting and meniscal transplantation codes: That's not all: NCCI will also bundle the following spinal injection codes into the above new knee arthroscopy codes: 62318-62319, 64415-64417, 64450, 64470, 64475 and 69990. EMG Bundled Into 469 Codes NCCI makes code 95870 (Needle electromyography; limited study of muscles in one extremity or non-limb [axial] muscles [unilateral or bilateral], other than thoracic paraspinal, cranial nerve supplied muscles, or sphincters) a component of 469 codes, including 60 musculoskeletal system surgery codes such as 22558 (Arthrodesis, anterior interbody technique, including minimal diskectomy to prepare interspace [other than for decompression]; lumbar). You won't be able to use a modifier to override these edits.
Reality: "Technically, this type of wound care is already included in any surgical procedure that an orthopedic surgeon would perform," says Jay Neal, an independent coding consultant in Atlanta.
"If you go above and beyond devitalized tissue removal along with a surgical procedure, you should be billing higher-level codes than 97597 and 97598 anyway," Neal says.
Spinal Injection Codes Under Fire
You can use a modifier to separate all of the edits affecting the new knee codes, as long as you maintain documentation demonstrating the nature of the separate and distinct services.
Visit the CMS Web site at www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the NCCI edits.
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