Orthopedic Coding Alert

Follow our experts- advice to save your claims from the denial pile

Orthopedic practices reporting spine surgeries at separate levels should avoid billing several base codes on the same claim -- a reality NCCI won't let you forget.

Version 12.3 of the National Correct Coding Initiative (NCCI) took effect Oct. 1, and you-ll have to rein in your spine surgery coding if you want to stay on the right side of the rules.

Pay Attention to Bundling Patterns

The new bundles affect scores of spinal codes, but they all follow the same pattern of bundling base codes for one site into base codes for another. For instance, the NCCI now bundles the posterior cervical vertebrae excision code (22100) into the posterior thoracic vertebrae excision code (22101). Likewise, the posterior thoracic excision code (22101) is bundled into the lumbar code (22102), and so on.

The NCCI follows the same pattern with quite a few different spinal procedures. For instance, the thoracic posterior arthrodesis code (22610) is bundled into both the cervical and lumbar posterior arthrodesis codes (22600 and 22612).

Because most spine surgeons perform multilevel procedures regularly, some coders might scratch their heads about why the NCCI would bar them from billing several levels at the same time. But experts say the new rules simply strengthen correct coding rules.

-Both the 221xx series and the 2261x series have separate codes that were created for billing additional levels,- says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates PA in Salisbury, Md. -I think some people, if they are doing a fusion that crosses levels, will bill out the base code 22610 and 22612, but that is not correct coding,- she says.

Right way: -You should pick whichever base code has the higher value, and then use the appropriate add-on code,- Follebout says.

In addition, the edit will keep surgeons from collecting more reimbursement than they should. -This will prevent coders from choosing two higher-valued base codes instead of choosing one base code and then the lower-valued add-on codes,- says Kim Barnard, CPC, coder at the Cleveland Clinic's Spine Institute. -It's no different than the kyphoplasty and laminectomy codes. Medicare is just trying to prevent people from billing two base codes and overutilizing the RVU system.-

Example: The surgeon performs posterior arthrodesis at one thoracic level and one cervical level below C2. You should report 22600 (Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment) as your base code, followed by +22614 (... each additional vertebral segment [list separately in addition to code for primary procedure]) to represent the thoracic level.

Look for Knee, Nursing Facility Bundles

The NCCI also shines its light on several knee codes, bundling 29873 (Arthroscopy, knee, surgical; with lateral release) into 27422 (Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release [e.g., Campbell, Goldwaite type procedure]).

And you-ll face denials if you bill arthroscopic synovectomy code 29876 with meniscectomy code 29880. The NCCI now considers 29876 a component of 29880.

You-ll find new mutually exclusive edits that affect the following nursing facility care codes:

- 99304-99306 -- Initial nursing facility care, per day, for the evaluation and management of a patient ...

- 99307-99310 -- Subsequent nursing facility care, per day, for the evaluation and management of a patient ...

- 99315-99316 -- Nursing facility discharge day management ...

All of the codes from this range will become mutually exclusive with most of the other codes from the Nursing Facility Services section, which was overhauled in 2006.