Orthopedic Coding Alert

Avoid spinal surgery denials by paying attention to CCI changes You can pretty much give up on billing spinal manipulation with other spinal surgeries, thanks to version 13.3 of the Correct Coding Initiative (CCI), effective Oct. 1. Last month, we gave you the great news that the CCI is revoking the edit that bundled cervical discectomy code 63075 with cervical arthroplasty code 0090T. But CCI delivered more than just good news this round. Beginning Oct. 1, spinal manipulation code 22505 (Manipulation of spine requiring anesthesia, any region) becomes a component of most of the codes in the spinal surgery section from 22532 to 22865. A modifier will do you absolutely no good in dealing with this new edit, but on the brighter side, many practices were already including 22505 in their spinal procedures. "If there is a spinal fracture that is treated in an open fashion, that would automatically include the manipulation," says Kathleen F. Nelson, orthopedic surgical coder with Fletcher Allen Health Care in Vermont. "Therefore, 22505 would not be submitted separately." Looking for Closure? Medicare Won't Pay for It Also effective Oct. 1, CPT codes 12001-12007 (simple repair of superficial wounds) become components of four dozen codes, each from the musculoskeletal system section. In a nutshell: Thanks to CCI, you probably can't bill for one of those superficial wound repair codes at the same session as a deep excision, a tissue graft, a radical tumor resection, a deep incision and drainage (I&D), a radical resection, a spine surgery, or a lesion excision. Layered wound closure codes (12031-12037 and 12041-12047) will also become components of most of the same surgical codes. Complex wound repair codes 13100-13132 (except for the add-on codes) are also slated to become components of a few dozen surgical codes. Although most surgeons weren't separately billing the simple closure, some may be dismayed by the layered closure bundle. "Most of my surgeons already consider the -simple- repair inclusive of the more restorative treatment anyway and do not submit separately," Nelson says, "But the layered closure may be an issue because of the degree of difficulty involved with the closure. We will have to wait and see, case by case." Similarly, superficial facial wound repair codes 12011-12018 became components of a number of surgical codes, including several facial fracture care codes. Layered facial wound repair codes 12051-12057 and complex facial wound repair codes 13150-13152 will be components of many of the surgical (and facial fracture care) codes as well. You can use a modifier to override those edits, but be prepared to justify the need for a separate wound repair. CPT codes 12020-12021, for treatment of superficial wound dehiscence, also became components of about 58 surgical codes. [...]