Orthopedic Coding Alert

The only spinal surgery codes that this longstanding edit didn't affect were four add-on codes (22328, 22585, 22614 and 22632) and some codes that CPT added in 2004 (22532-22534).

"The deletion that will help us the most is the one that bundled 22849 with the other codes," says Christine Hauer, coding supervisor at Hart Orthopaedics in Kansas City. "We've had problems in the past when the surgeon had to replace pins during surgery, and the insurers would deny the pin replacement and say it was included in the surgery."

NCCI Institutes New Pin Insertion Edit

The new edition of NCCI isn't all good news. Version 10.3 debuts several wire/pin insertion edits, bundling 20650 (Insertion of wire or pin with application of skeletal traction, including removal [separate procedure]) into 16 surgical codes, such as 23585 (Open treatment of scapular fracture [body, glenoid or acromion] with or without internal fixation) and 24665 (Open treatment of radial head or neck fracture, with or without internal fixation or radial head excision), among others.

The upside: Fortunately, this new bundle won't be as bad as it may sound: because most of the comprehensive codes in this group already include the language "with or without internal fixation," you probably weren't billing 20650 for your wire or pin insertions with these procedures anyway. In addition, you can still use a modifier (such as modifier -59, Distinct procedural service) to separate the edit if your physician inserts a pin through an incision that is separate from the surgical site.

"We rarely bill for 20650," says Leslie A. Follebout, CPC, coding analyst at Peninsula Orthopaedic Associates PA, in Salisbury, Md. "The only time I can think of is when the patient has a femur fracture and doesn't get to surgery that day, sometimes the surgeon will put him in traction. I'll bill for it in that case."

Note: Visit the CMS Web site at www.cms.hhs.gov/physicians/cciedits/default.asp for links to documents that explain the edits, including the NCCI Policy Manual for Part B Medicare Carriers, the Medicare Carriers Manual, and an NCCI Question-and-Answer page.