Primary Care Coding Alert

Tip: Exploration and drainage codes override some biopsy or synovectomy choices.

The latest edits from the National Correct Coding Initiative (CCI) went into effect April 1, and contain some arthrotomy pairings that FP offices should check out. The affected arthrotomy codes include:

CCI 17.1 considers the arthrotomy procedures part of non-mutually exclusive edits, meaning a physician might carry out the procedures during the same care session, but the procedures aren't typically reported together. One of the codes (the component code) is considered to be included in the services represented by the other (comprehensive) code of the pairing. If the physician carries out the entire comprehensive procedure, you should only bill the comprehensive code in place of the individual parts or components.

In the latest edits, arthrotomy is the comprehensive procedure when paired with particular codes during the same patient encounter.

Assess Joint When Deciding Arthrotomy Code

If your physician completes arthrotomy on multiple finger or wrist joints, double check the joints he treats before choosing your code. Pay particular attention to these procedures:

Under CCI 17.1 edits, arthrotomy codes 26075 and 26080 for metacarpophalangeal or interphalangeal joints override the three codes listed above. That means you'll only report 26075 or 26080 if your physician performs any of these three procedures during the same encounter.

Don't Trip Over Foot Code Pairings

The same mindset applies to some foot procedures. CCI 17.1 lists arthrotomy codes 28022 and 28024 as the comprehensive code when paired with:

Good news: Each of these edit pairs carry a modifier indicator of "1," meaning you can sometimes bypass the edit by filing your claim with an appropriate modifier. Be sure you have enough supporting documentation to justify payment for both codes before filing with a modifier such as 59 (Distinct procedural service). For example, if you're preparing to bill 26100 with 26075 because the physician completed the procedures on different hands, the documentation should show that one procedure was done on the left hand and the other was done on the right.

"Given the multiplicity of joints in the hands and feet and the multiplicity of codes describing arthrotomy of these joints, it's somewhat understandable that there might be edits to avoid coding arthrotomy more than once for the same joint on the same date," says Kent J. Moore, manager of healthcare delivery and financing systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan. "When you plan to submit more than one of these codes for a given date of service, ensure that the medical record reflects the services were performed on different joints and use a modifier, as needed, to reflect that fact when submitting the claim."