Orthopedic Coding Alert

Question: I heard the new Category III codes came out. Is there anything I should know for my orthopedic practice?

California Subscriber

Answer: The American Medical Association (AMA) released four new transforaminal injection codes in January and one plasma injection code. They went into effect July 1, so update your systems accordingly:

• 0228T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level
• 0229T -- ... each additional level (List separately in addition to code for primary procedure)
• 0230T -- Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level
• 0231T -- ... each additional level (List separately in addition to code for primary procedure)
• 0232T -- Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed.

The additions finally give coders specific choices for epidural steroid injections, says Catherine Brink, BS, CPC, CMM, CMSCS, president of Healthcare Resource Management, Inc., in Spring Lake, N.J. Before filing your first claim with 0228T-0223T, however, pay attention to the associated parenthetical notes regarding techniques and guidance.

You'll also see new codes for internal fixations systems for rib fractures. They are:

• 0245T -- Open treatment of rib fracture requiring internal fixation, unilateral (e.g., flail chest); 1-2 ribs
• 0246T -- ... 3-4 ribs
• 0247T -- ... 5-6 ribs
• 0248T -- ... 7 or more ribs.

You may find, however, that you'll rarely use these -- except on patients whose rib fractures are not healing.