Orthopedic Coding Alert

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:
  97597 - Removal of devitalized tissue from wound[s], selective debridement, without anesthesia [e.g., high-pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps], with or without topical application[s], wound assessment, and instruction[s] for ongoing care, may  include use of a whirlpool, per session; total wound[s] surface area less than or equal to 20 square centimeters
  97598 - ... total wound[s] surface area greater than 20 square centimeters. 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.
 
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. 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:
  29866 - Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft)
  29867 - Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty)
  29868 - Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral.

Spinal Injection Codes Under Fire 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.
 
You can use a modifier to separate all of the edits affecting the new knee codes, as long as you maintain documentation [...]