Orthopedic Coding Alert

ASC and surgical coders should keep in contact

In some cases, the ASC coder will review the physician's documentation and select a specific CPT code to report the services. The orthopedic surgeon's coder will review the same documentation but will come up with a different code. Because both the ASC and the physician must submit the same code, any discrepancies can bring claim submissions to a screeching halt, with both coders at an impasse.

What can you do to avoid this problem? If the impasse is due to a documentation issue, both parties should talk to the surgeon, says Lisa Weston, CPC-H, LHRM, director of ambulatory surgery coding services with The Coding Network LLC. -If additional information is needed in the report, then a simple addendum can be performed,- she says. -If this is not the case, then they should submit the coding question to a third unbiased entity.

-A review of the case by another certified coder/consultant can help them to determine proper coding, as well as provide them with the documentation to support it.-

When billing orthopedic procedures performed in ASCs, the following errors crop up most frequently, Weston says:

• Coding abrasion arthroplasties as 29879 when the documentation does not support the code.'-The operative report should clearly state -subchondral- or -bleeding bone- - to support 29879, Weston says. Another common problem is the omission of reporting additional units of 29879 when the surgeon performs this in more than one compartment.
• Distal radius fractures. -While they are great codes to have, the surgeon doesn't always indicate the
• number of fracture fragments that are being fixated,- Weston says.
• Misuse of 23420 (Reconstruction of complete shoulder cuff avulsion, chronic). The October 2005 CPT Assistant states that this code -is intended to identify an old tear. This type of extreme tear usually requires rearrangement of the normal anatomy and sometimes grafting with either biological or nonbiological material for repair.-
• Misuse of 23120 (Claviculectomy; partial) and 29824 (Arthroscopy ... distal claviculectomy). You shouldn't use these codes for coplaning of the AC joint.
• Omission of 29822 (Arthroscopy, shoulder ... debridement, limited) when debridement is the definitive treatment for a structure that is not involved in other arthroscopic procedures (such as labral debridement with AC joint decompression and acromioplasty), Weston says.

The two codes are both reportable in this scenario because the labral debridement is done in the glenohumeral joint while the subacromial decompression is performed in the subacromial space.