Orthopedic Coding Alert

Question: Encounter notes indicate that the provider performed closed treatment of a fracture of a vertebral process in the office. I cannot find a code that exactly lines up with this surgery; I was thinking 22310 or 22315. Should I report one of these codes?

Tennessee Subscriber

Answer: You should not report either of the codes you mentioned. Instead, roll the work into the overall evaluation and management (E/M) level and choose an E/M code based on encounter specifics. Be sure to satisfy the new rules for reporting codes 99202 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.) through 99215 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.) — namely, that you’ll use total encounter time or medical decision making (MDM) as the sole determinant when choosing an E/M level.

Explanation: Both 22310 (Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing) and 22315 (Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction) are for different procedures than the one you describe, and would likely be met with swift denials.

The code you might have wanted to report for this service was 22305 (Closed treatment of vertebral process fracture(s)). CPT^® deleted 22305 a few years ago however, and replaced its spot in the manual with this guidance: “22305 has been deleted. To report, see the appropriate evaluation and management codes.”