Orthopedic Coding Alert

Question: Can my physician bill for a fitting and education of a brace during the postoperative period for an anterior cruciate ligament (ACL) surgery? I found 97760, but can I report this separately, or is it considered part of the ACL surgery's global period?

Answer: The Correct Coding Initiative (CCI) edits do not bundle 97760 (Orthotic[s] management and training [including assessment and fitting when not otherwise reported], upper extremity[s], lower extremity[s] and/or trunk, each 15 minutes) into any of the ACL repair codes, for example 27407 (Repair, primary, torn ligament and/or capsule, knee; cruciate). But this doesn't automatically mean that you can report 97760 in the situation outlined in the question above.

According to the December 2005 CPT Assistant, 97760 "includes the provider's time associated with determining the proper orthotic design in relation to the patient's skin integrity, sensibility and healing of tissues with or without surgical repair (e.g., static vs. dynamic, pre-fabricated vs. custom designed, choice of materials such as thermoplastic, pulleys, and elastic tendon). The code also includes the fitting of the orthotic, training in use, care and wearing time of the orthotic, and brief instructions in exercises that are to be performed while the orthotic is in place."

What this means: When deciding whether to report 97760, examine your physician's documentation to make sure he's noted each of these decision-making processes. Most national and local Medicare coverage determinations note that physical therapists report this code most often and that this service should take no longer than 30 minutes. Consequently, you might run into frequency edits if you attempt to report more than two units of 97760.