Orthopedic Coding Alert

Find opportunities with arthrodesis and instrumentation procedures If you missed that spinal bone graft codes 20930-20938 became add-on codes in 2008, you could be making costly mistakes on your claims. Here's a look at the rules you should apply to be sure you get maximum payment for these spine claims -- and any add-on claims. Add-On Can't Stand Alone You should never report an add-on code alone. By definition, an add-on code describes an "additional" service that occurs only at the same time as another, more extensive procedure, says Suzan Berman-Hvizdash, CPC, CPC-E/M, CPC-EDS, physician educator for the department of surgery at the University of Pittsburgh Medical Center. Generally, CPT will include an editorial note, following the add-on code's descriptor, to instruct you as to which primary procedure codes should precede that add-on code. Example: For all spinal bone graft procedures 20930-20938, the appropriate, approved primary procedures are 22319 (fracture treatment) and 22532-22533, 22548-22558, 22590-22612, 22630 and 22800-22812 (arthro-desis/spinal fusion). You can find these instructions immediately following each of the code descriptors for 20930-20938. You may occasionally report more than one type of add-on code during the same operative session. For instance, in addition to arthrodesis, spinal bone grafts also frequently occur during the same session as spinal instrumentation procedures (22840-22855). The spinal instrumentation procedures are represented with add-on codes, and you may report them in addition to any spinal bone grafts and arthrodesis. CPT supports this coding with instructions preceding both the arthrodesis and spinal instrumentation codes advising, "To report bone graft procedures, see 20930-20938. (Report in addition to code[s] for definitive procedure[s].)" And although the Correct Coding Initiative (CCI) bundles various bone grafts into many orthopedic procedures, such bundles do not apply to spinal bone grafts with arthrodesis (22548-22812) and/or spinal instrumentation (22840-22855) procedures. Avoid Modifier 51, or Pay the Price You should never append modifier 51 (Multiple procedures) to a designated add-on code. Modifier 51 designates a procedure or service that a provider usually performs independently but, in the cited case, performs it at the same time as another procedure. Because CPT already defines add-on codes as additional services or procedures, modifier 51 is redundant and, for some payers, can even harm your reimbursement, says Marcella Bucknam, CPC, CCS, CPC-H, CCS-P, manager of compliance education at the University of Washington Physicians. CPT stresses this point by stating, "All add-on codes found in the CPT book are exempt from the multiple procedure concept." That is, the payment value assigned to these codes reflects their status as "additional procedures," and therefore any further reduction in reimbursement is unwarranted and unjustified. The AMA's CPT 2008 Changes: An Insider's View goes even further, stating, "As modifier 51 exempt codes are typically [...]