Orthopedic Coding Alert

Bonus: Learn when your physician's requests will throw your coding out of joint   To properly report shoulder procedures, you have to know what to report -- and when. Just as important, you have to remember what not to report to stay out of auditors- cross hairs. Try your hand at three of the most challenging operative notes that Beth P. Janeway, CPC, CCS-P, CCP, shared during a recent Coding Institute teleconference. A thorough knowledge of shoulder anatomy is crucial because you more readily know what your orthopedist is doing, says the Winston-Salem, N.C.-based consultant. And being acquainted with anatomy will give you a sound understanding of when you should claim open procedures, she adds.
Arthroscopy Plus Arthrotomy? Use 1 Code   Scenario 1: A 20-year-old male was playing football with friends and was tackled, dislocating his right shoulder. The provider reduced it in the emergency department (ED) and sent the patient to physical therapy, but the patient feels his shoulder is still unstable. The orthopedist performs a physical exam, which demonstrates a positive anterior apprehension sign, and the patient has a normal neurological exam. X-rays of the shoulder are negative, but magnetic resonance imaging (MRI) reveals a large Bankart lesion. Arthroscopic evaluation demonstrates a large Bankart lesion with a significant Hill-Sachs lesion. The orthopedic surgeon converts to an open procedure and performs an arthrotomy. He repairs the glenoid labrum, but the shoulder remains unstable, so he places a bony block anteriorly to further stabilize the shoulder. The surgeon then closes the wound and places the patient in a shoulder immobilizer. Watch out: In cases like these, many physicians want coders to use 29805 (Arthroscopy, shoulder, diagnostic, with or without synovial biopsy [separate procedure]) plus an arthrotomy code, Janeway warns. -That is not OK,- she says. Instead, you should use the open code alone, even though the physician did an arthroscopic exam before opening. Exception: -The only time you would use an arthroscopic code as well as an open code is when the scope is a completely separate part of the procedure,- Janeway says. For example, you could code for both if the surgeon did something arthroscopically in one shoulder area and then opened up another part of the shoulder to do something else. Coding solution: Consequently, you would correctly code scenario 1 as 23460-RT (Capsulorrhaphy, anterior, any type; with bone block; right side).
Time May Be Key for Code Choice Scenario 2: A 48-year-old ED physician falls off his bicycle and fractures his clavicle. In his ED, he places himself in a figure-of-eight splint, which he removes after 10 days. Four weeks later, he presents to a local orthopedist, his friend, who advises him to [...]