Orthopedic Coding Alert

Version 12.0 institutes scores of edits involving new codes 22523, 22524

CPT introduced several new orthopedic codes last fall, and now the National Correct Coding Initiative (NCCI) wants to make sure you don't double-dip when you use the new kyphoplasty, I&D and grafting codes.

The following is a partial list of the many codes that version 12.0 of the NCCI, which took effect on Jan. 1, bundles into the new kyphoplasty codes (22523-22524):

- vertebroplasty (22520-22521)
- some injections (such as 64415, 64417, 64475)
- spine fracture treatment (22310)
- biopsy (20220)
- cage application (22851).

-My surgeon told me that all the new edits for kyphoplasty make sense, except for the bundling of 64415 and 64417,- says Leslie Follebout, CPC, coding department supervisor at Peninsula Orthopaedic Associates PA, in Salisbury, Md. Because the new kyphoplasty descriptor already states that fracture reduction and biopsy are included in the procedure, coders probably expected those edits.

But anatomically, injecting the brachial plexus or axillary nerve wouldn't normally affect the pain relief in areas where the kyphoplasty would be done, so those edits do not make sense, Follebout says.

Good news: Because these edits include a -1- indicator, you can use a modifier (such as 59, Distinct procedural service) to separate these bundles if necessary.

NCCI Puts a Grip on Grafting Codes

The new version of NCCI also bundles several musculoskeletal codes (mostly in the 29000 series--casting and strapping) into the new grafting codes (15110, 15115, etc.), and you can separate the bundles if you use a modifier.

Potential rationale: -Perhaps, like other casting procedures, they are bundling the casting with the procedure, similar to fracture care,- says Denise Paige, CPC, coding and billing manager at Beach Orthopedic Associates in Long Beach, Calif. -Maybe they are thinking that a cast would always be part of the grafting procedure and not separately payable.-

Hand surgery update: The NCCI will now bundle the new grafting codes (15110, 15115, 15130, etc.) into fasciectomy codes 26121 (Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting [includes obtaining graft]) and 26123 (Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting [includes obtaining graft]).

I&D Codes Shouldn't Surprise Coders

To ensure that coders don't double-dip incision and drainage reimbursement, the NCCI now bundles the previous I&D codes (10060, 10140-10180) into the new spinal I&D codes 22010 (Incision and drainage, open, of deep abscess [subfascial], posterior spine; cervical, thoracic, or cervicothoracic) and 22015 (... lumbar, sacral, or lumbosacral).