Orthopedic Coding Alert

The new edition of CPT also cleans up graft language and introduces new -T- codes

Coding inpatient consultations is about to get easier, thanks to a clarification in CPT 2007.

Last month we told you about some of the new CPT changes that will affect orthopedic coders, but the new CPT manual still has more in store for your practice. Check out the following changes that you can apply to your 2007 superbills.
 
CPT Excludes Follow-Up Inpatient Consult Codes

You may recall that CPT 2006 deleted follow-up inpatient consult codes (99261-99263) but left the descriptors of the remaining codes the same. CPT 2007 tidies up the descriptors to eliminate the word -initial- and simply refer to these services as -Inpatient consultation for a new or established patient --

This change shouldn't affect the way that coders report their inpatient consult services. -This descriptor change for 99251-99255 was necessary because CPT previously deleted the follow-up consult codes,- says Pat Strubberg, CPC, coder at Patients First Health Care in Washington, Mo. -The word -initial- would be unnecessary and could be confusing for some.-

As in 2006, the physician should report only one consultation per admission. You should use subsequent hospital care codes (99231-99233) or subsequent nursing facility care codes (99307-99310), depending on the site of service, for subsequent services during the same admission.  These subsequent services include visits to complete the initial consultation, monitor progress, revise recommendations, or address a new problem. 

Example: The managing physician asks your surgeon to provide a consultation for a hospital inpatient complaining of right arm and wrist pain. The surgeon documents the request, examines the patient and shares his findings with the managing physician.

In this case, you should report an inpatient consult (99251-99255).

The next day, the managing physician once again asks the surgeon to examine the patient because of new symptoms, this time in the patient's right hand and fingers.

For the follow-up visit, claim subsequent hospital care (for instance, 99232, Subsequent hospital care, per day, for the evaluation and management of a patient ...). Even though this visit may look like a consult, you must report it as subsequent care.

Get Specific With New Graft Codes

CPT 2007 brings you four new codes for surgical skin preparation, which will allow for more precise identification of the procedures your hand surgeon performs -- and which might result in more equitable payments as well.

Out with the old: Previously, CPT listed two codes to identify surgical preparation or creation of graft recipient site by excision (15000 for the first 100 sq cm or 1 percent of body area of infants and children, and 15001 for each additional 100 sq cm or 1 percent of body area of infants and children).

In with the new: CPT 2007 deletes 15000 and 15001 and replaces them with the following:

- 15002 -- Surgical preparation or creation of recipi ent site by excision of open wounds, burn eschar or scar (including subcutaneous tissues), or incisional  release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children

- +15003 -- ... each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary  procedure)

- 15004 -- Surgical preparation or creation of recipient site by excision of open wounds, burn eschar or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children

- +15005 --... each additional 100 sq cm or each additional 1% of body area of infants and children (list separately in addition to code for primary procedure).

-I think this is a positive development,- says John F. Bishop, PA-C, CPC, MS, CWS, president of Tampa, Fla.-based Bishop & Associates. -The skin graft and replacement codes are themselves divided according to anatomic area, primarily because the face, scalp, eyelidshands and so on require more work and a greater level of precision than the chest or back or thigh, for instance,- he says. -As a result, codes describing grafts to the face and other delicate areas reimburse at a greater rate than those describing grafts to the trunk, arms and legs.-

Although Medicare has not yet released the 2007 physician fee schedule, Bishop predicts that 15004 and 15005 (which describe site preparation for the delicate areas of face, scalp, etc.) will likely reimburse better than 15002-15003 (which describe preparation of the trunk, arms or legs).

In any case, 15002-15005 will better describe the work the surgeon performs than the previous codes  15000-15001 (which did not differentiate by anatomical location).

Take Note of New Spine T Codes

As we noted last month, spine surgeons should no longer report category III codes 0090T-0098T for total disc arthroplasty. Starting on Jan. 1, you should instead report the following codes:

- 22857 -- Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, single lumbar interspace . 
                          
- 22862 -- Revision including replacement of total disc arthroplasty (artificial disc) anterior approach, lumbar, single interspace

- 22865 -- Removal of total disc arthroplasty (artificial disc), anterior approach, lumbar, single interspace. 

If you were left wondering how to report additional interspaces, we-ve got the answer. CPT also introduced add-on codes to accompany these total disc arthroplasty codes:

- +0163T -- Total disk arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar,  each additional interspace

- +0164T -- Removal of total disc arthroplasty, anterior approach, lumbar, each additional interspace

- +0165T -- Revision of total disc arthroplasty, anterior approach, lumbar, each additional interspace.

Example: If your surgeon performs total disc arthroplasty on two lumbar interspaces, you would report one unit of 22857 and one unit of 0163T.

Not All New Codes Made the Book

Add this to your CPT book: The AMA also released two new T codes for spine coders, but these two codes did not make it into the CPT 2007 book. However, these codes are effective as of Jan. 1:

- 0171T -- Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; single level

- 0172T -- ... each additional level addition to code for primary procedure) (use 0172T in conjunction with code 0171T).

These codes refer to the surgeon's work placing an implant between two adjacent spinous processes to treat spinal stenosis using an interspinous process distraction (IPD) procedure. Now, only the X-STOP implants from St. Francis Medical Technologies are FDA-approved. Other implants that are now in the clinical trial phase are Wallis System (Abbott Spine), Coflex (Paradigm), and DIAM (Medtronic).

Reimbursement for this procedure is rare because many payers consider it investigational, but perhaps the introduction of the T code can show insurers that spine surgeons are performing it more frequently and may open up more reimbursement avenues for orthopedic surgeons.