Orthopedic Coding Alert

But new wound VAC codes won't bring in any reimbursement Medicare's 2005 Physician Fee Schedule rings in the new year with healthy relative value units (RVUs) for most new CPT codes. But if you were expecting debridement-quality payment for your wound VAC services, you'll surely be disappointed.
 
The new knee surgery and laminoplasty codes will pay more than $1,000 each, before being adjusted for
geographic location. Laminoplasty Pay Exceeds Some Expectations  The new laminoplasty codes, which CPT introduced effective Jan. 1, 2005, follow:
  63050 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments
  63051 - Laminoplasty, cervical, with decompression of the spinal cord, two or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini-plates], when performed). Medicare assigned 37.23 nonfacility RVUs to 63050, totaling payment of about $1,410, and assigned 42.36
nonfacility RVUs to 63051, giving it a base rate of about $1,605.
 
According to the AMA's CPT Changes 2005: An Insider's View, these new codes "involve procedures which leave portions of the posterior elements intact," unlike the existing posterior decompression codes 63015 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], more than two vertebral segments; cervical) and 63001 (Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy [e.g., spinal stenosis], one or two vertebral segments; cervical), which involve complete removal of the posterior spinal elements.
 
Good news: The new RVUs demonstrate the complexity that goes into the "open-door" laminoplasty that the new codes describe. "Code 63015 only pays about $1,357, and 63001 pays about $1,098, so Medicare clearly understood the additional difficulty that goes into the open-door laminoplasty," says Heather Corcoran, coding manager at CGH Billing Services in Louisville, Ky.
 
Knee Procedures Score High RVUs Medicare plans to pay about $1,050 for the new mosaicplasty code 29866 (Arthroscopy, knee, surgical; osteochondral autograft[s] [e.g., mosaicplasty] [includes harvesting of the autograft]), and about $1,249 for the corresponding mosaicplasty with allograft code 29867 (Arthroscopy, knee, surgical; osteochondral allograft [e.g., mosaicplasty]).
 
In addition, Medicare assigned a healthy 44.71 non-facility total RVUs to the new meniscal transplantation code 29868 (Arthroscopy, knee, surgical; meniscal transplantation [includes arthrotomy for meniscal insertion], medial or lateral), which will bring about $1,694 for this procedure.
 
Caution: "Remember that 29868 already includes the $600 to $650 base pay that you'd get for the meniscectomy itself if you perform it in the same compartment as the transplant," Corcoran says, "so don't bill the meniscectomy (29881-29882) separately." Wound VAC Code Payment Doesn't Materialize Many orthopedic coders were thrilled to hear that the AMA created two new [...]