Orthopedic Coding Alert

You also have more moderate sedation edits to apply.

Version 14.3 of the Correct Coding Initiative (CCI) -- effective Oct. 1, 2008 -- contains 3,273 newly bundled code pairs. Good news: In most cases, however, the edits simply enforce CPT or CMS coding rules.

If you want to keep your coding accuracy at the topmost level, however, here are three ortho changes you should note.

1. Take Note of this Swapped Pair

CCI -swaps- some edit pairs, which means that the previous column 1 code has moved to column 2, and vice versa.

Orthopedic practices should note that knee arthroplasty code 27446 (Arthroplasty, knee, condyle and plateau; medial OR lateral compartment) is now mutually exclusive to patellar arthroplasty codes 27437 (Arthroplasty, patella; without prosthesis) and 27438 (... with prosthesis).

-Thank goodness for this,- says Jay Neal, a consultant in Atlanta. -It should have been the other way around from the get-go.-

What this means: Your physician is doing a medial unicompartmental replacement and a patella resurfacing. You should apply modifier 59 (Distinct procedural service) on the prosthesis code (27438), provided you have documentation to support why this second procedure is distinct from the first (for instance, the physician performed the procedures on opposite knees).

2. New Edit for Foot and Ankle Surgeons

If you typically report 28306 (Osteotomy, with or without lengthening, shortening, or angular correction, metatarsal; first metatarsal) and 28292 (Correction, hallux valgus [bunion], with or without sesamoidectomy; Keller, McBride, or Mayo type procedure), then you should change your coding practices.

CCI now bundles 28292 into 28306. CCI lists the rationale as -standards of medical/surgical practice.-

The modifier indicator is -1,- meaning you can override an edit with a modifier when appropriate, says Maggie M. Mac, CMM, CPC, CMSCS, CCP, ICCE, consulting manager for Pershing, Yoakley and Associates in Clearwater, Fla.

3. Don't Overlook Moderate Sedation Edits

Also among edits affecting orthopedic practices are those revolving around 99148 (Moderate sedation services [other than those services described by codes 00100-01999], provided by a physician other than the healthcare professional performing the diagnostic or therapeutic service that the sedation supports; under 5 years of age, first 30 minutes intra-service time) and 99149 (- age 5 years or older, first 30 minutes intra-service time).

CCI 14.3 bundles these moderation sedation codes into many ortho surgeries, including 20982 (Ablation, bone tumor[s] [e.g., osteoid osteoma, metatasis] radiofrequency, percutaneous, including computed tomographic guidance) and percutaneous intradiscal electrothermal annuloplasty codes 22526-22527.

Watch out: While this may not come as a surprise, you should be wary of instances when you have two physicians in one group practice performing two different services -- such as an orthopedic surgeon performing the bone tumor ablation (20982) and an anesthesiologist performing the moderate sedation (99148).