Orthopedic Coding Alert

Question: Does the latest version of the NCCI hold any problematic edits for orthopedic surgeons?

Washington Subscriber
 
Answer: The latest edition of the National Correct Coding Initiative (NCCI, version 12.2) won't affect your bottom line too badly this time around.
 
The new version, which became effective on July 1, now bundles elbow arthrotomy code 24006 (Arthrotomy of the elbow, with capsular excision for capsular release [separate procedure]) into radical resection of elbow code 24149 (Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release [separate procedure]).
 
You can use a modifier (such as modifier 59, Distinct procedural service) to separate the edits, but only if you can demonstrate the distinct nature of the two surgeries. For instance, a modifier would apply if the surgeon performed the elbow arthrotomy on the left elbow and the radical resection on the right elbow.
 
In addition to the new elbow edit, the latest version of the NCCI also bundles strapping code 29540 (Strapping; ankle and/or foot) into injection code 20550 (Injection[s]; single tendon sheath, or ligament, aponeurosis [e.g., plantar -fascia-]). This new bundle also accepts a modifier to separate the edits if you can demonstrate the distinct nature of the services.
 
The NCCI edits are available online at the CMS Web site www.cms.hhs.gov/NationalCorrectCodInitEd/NCCIEP/list.asp.

 -- Reader Questions were reviewed by Heidi Stout, CPC, CCS-P, coding and reimbursement manager at UMDNJ-RWJ University Orthopaedic Group in New Brunswick, N.J.; and Bill Mallon, MD, orthopedic surgeon and medical director at Triangle Orthopaedic Associates in Durham, N.C.