Orthopedic Coding Alert

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Should you bill pressure measurements per compartment, or extremity?

Coding compartment syndrome can be trying, but if you remember to code compartment measurements per extremity and not per compartment, you'll be on the right track. Check out the following questions that our readers submitted, along with advice from the pros.

Do Compartment Syndrome ICD-9 Codes Exist?
 
Question: Which ICD-9 code should we report for compartment syndrome?

Answer: If trauma caused the patient's condition, you should report 958.8 (Other early complications of trauma) as your diagnosis code.
 
If the patient had non-traumatic compartment syndrome, you should report 729.9 (Other and unspecified disorders of soft tissue).

When physicians perform compartment pressure measurements, they are evaluating compartment syndrome - when swelling in a limb can cause damage to the underlying tissues, says Denise Paige, CPC, the coding manager at Beach Orthopedic Associates in Long Beach, Calif., and president of the American Academy of Professional Coders' Long Beach chapter.

If the orthopedist finds compartment syndrome, the patient may eventually require a compartment release (decompression fasciotomy), Paige says.

Should We Bill per Compartment?

Question: Which CPT code describes compartment pressure measurements? Can we bill the measurements per compartment or extremity, or do we report it once per date of service?

Answer: You should report 20950 (Monitoring of interstitial fluid pressure [includes insertion of device,e.g., wick catheter technique, needle manometer technique] in detection of muscle compartment syndrome) for these measurements.

According to CPT, 20950 describes the following service: The physician inserts an interstitial fluid pressure monitoring device into a muscle compartment using a wick catheter" needle or other method. The physician checks the monitoring device for escalation of pressure which indicates developing compartment syndrome and tissue ischemia. Once the data has been gathered the catheter or needle is removed."

Coding experts recommend that you bill 20950 per extremity per session. You should not bill this code per compartment.

Example: The orthopedic surgeon measured compartment pressures in anterior and posterior compartments of bilateral legs.

You should code this scenario as 20950-RT (Right side) followed by 20950-LT (Left side). "If the patient had the studies done again at another time that day those measurements would be separately reportable " says Leslie A. Follebout CPC coding department supervisor at Peninsula Orthopaedic Associates PA in Salisbury Md.

Can You Report 20950 With Fasciotomy?

Question: We treated a car accident patient who had mid-shaft fractures of the tibia and fibula (823.22) and traumatic compartment syndrome (958.8). The surgeon performed a closed reduction of the tib-fib fractures and applied an external fixator. He also performed three- compartment fasciotomy to treat the compartment syndrome. Can we code all of these services as well as the compartment pressure measurement?

Answer: Yes. You should report the following codes for your surgeon's work: 

27752 - Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation with or without skeletal traction 
 

27602 - Decompression fasciotomy leg; anterior and/or lateral and posterior compartment(s)  

20690 - Application of a uniplane (pins or wires in one plane) unilateral external fixation system

20950.

The National Correct Coding Initiative does not bar you from reporting these codes together so the only modifier you should report is modifier -51 (Multiple procedures) on the second third and fourth line items unless your insurer does not require it.

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