The Orthopaedic Coding Coach 2004 Archives

Question:

When the procedure defined by CPT code 20670, superficial removal of pins is done in the office during the post op period from 25611, we are not getting paid. Are we coding this procedure correctly?

Answer:

If the surgeon or his/her partner placed the pins, the removal is included and not separately reimbursable unless the patient is taken to the OR for the removal under anesthesia. If the removal occurs in the OR occurs during the global period, append the appropriate modifier to the code for removal of the pins. If the pins are removed in the office during the global period, the removal is included and the physician would report 99024-post op no charge visit.

If the pins are removed in the office and the patient is outside the global period, the physician reports an E&M code, as appropriate.

Question:

Can you bill for a diagnostic knee arthroscopy followed by a total knee replacement in the same joint?

Answer:

No. According to the AAOS Global Service Data Guide code 27447, Total Knee Arthroplasty includes a diagnostic arthroscopy and it would not be separately reportable.

Question:

Occasionally we will have a patient who sees two of our physicians on the same day because our physicians are subspecialists in Orthopaedics. For example, the patient is seen by two different doctors for his/her shoulder problem and spine problem. We billed for both E&M services but only one physician was paid. What can we do to get payment for the other physician?

Answer:

It is a reimbursement problem when two physicians of the same specialty, in the same group practice, see a patient on the same day. It is not a reimbursement problem with two physicians of different specialties, in the same group practice, see a patient on the same day (e.g., your doctor and the internist). Generally payers do not recognize physician subspecialties. Therefore, they will reimburse for one E&M service per day per specialty in the same group practice. You can appeal for payment on the denied service by submitting both E&M progress notes to show that two separate services were indeed provided by two different physicians. Explain, in a cover letter, the subspecialty nature of your physicians’ expertise (e.g., fellowship training). Good luck!

Question:

We are constantly receiving denials on 20930 and 20936 when reporting these with the spinal fusion codes. Should we stop reporting them?

Answer:

If the physician performs the procedures described by 20936 (Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision) and 20930 (Allograft for spine surgery only; morselized) report these procedures along with the fusion codes. These codes are modifier -51 exempt codes, and as such, are not subject to the multiple procedure discount formula. Now here is the problem: Medicare assigns 0 RVUs for these procedures, thus Medicare will not reimburse the physician when these codes are reported. So just write-off to "disallowed" when Medicare does not pay. Other payors do reimburse. Appeal denials at least once and see what happens. If 20930 and/or 20936 are then paid, great! If the codes are not paid then write-off to "disallowed".

Question:

When coding for 22614, do you count the interspaces? Or do you count the vertebral segments? Our physician is reading vertebral segment from CPT; however, I have notes from the seminar you gave that says it should be coded by interspace.

Answer:

CPT 22614 is to be coded per interspace, not per segment. Although the CPT code says "per segment", all the experts (doctors and coders agree on this one!) feel it is not possible to fuse a "segment", rather the fusion occurs across the interspace. The other fusion/arthrodesis codes (eg. 22554) say per interspace.

Question:

What CPT code do I use if the physician only changes the acetabular liner or the head?

Answer:

Use the appropriate CPT code that describes the revision of one component and append the modifier -52, reduced services.

Question:

What CPT code do we report if the physician repairs a Bankart lesion through a scope?

Answer:

Per AMA, the appropriate code for an arthroscopic Bankart is CPT code 29806, Arthroscopy, shoulder, surgical; capsulorrhaphy

Question:

Do CPT codes 27756, 27758, and 27759 include fixation of both bones or do we use two codes?

Answer:

Per the CPT definition, these three codes are used one time only whether the physician treats one bone or both bones. The three codes all include in their description (with or without fibular fracture), thus the code is inclusive of a fracture of both bones, but is also the appropriate code to report if the patient only has a tibial fracture.

Question:

Our orthopaedic surgeon was wondering who the “other appropriate source” is in the CPT consultation definition. CPT states a consult is a physician requested service but then goes on to refer to the “other appropriate source. The physician is wondering if a request from an physical therapist or occupational therapist or Physician Assistant or Nurse Practitioner would constitute the other appropriate source?

Answer:

The CPT book does not specifically identify who may be considered the “other appropriate source.” According to the CPT Assistant (August 2001), they identify a physician assistant, nurse practitioner, doctor of chiropractic, physical therapist, occupational therapist, speech-language therapist, psychologist, social worker, lawyer or insurance company as a potential other appropriate source. Interestingly, these professionals typically have UPIN numbers from Medicare.

Medicare is very specific in identifying a Nurse Practitioner, Physician Assistant or Clinical Nurse Specialist as an appropriate source. Medicare typically does not recognize a chiropractor as an appropriate source.

Question:

The surgeon performed an arthroscopic debridement of the ACL. He could not find a CPT code for this procedure and was wondering how to report this to the payor. Can we code this and if yes, what CPT code would he use?

Answer:

He is correct in stating there is no CPT code for an arthroscopic ACL debridement. If his documentation supports the procedure he would report 29999, unlisted arthroscopic procedure

Question:

I am getting denials on cast applications during the global period as bundled in the primary procedure. Is this accurate?

Answer:

No, cast re-applications during the post operative global period are not included in the global surgical package, and as such may be reported separately. Append modifier -58 to the cast applications performed in the office during the global period, to indicate that these procedures are separately reportable as they are part of the treatment plan. Remember, you are in the global period of the primary procedure so your "bank" is locked.

Question:

Our surgeon asked a general surgeon to perform the retroperitoneal access to a paraspinal tumor which the orthopaedic surgeon removed. Is this co-surgery or does the general surgeon report 49010 for his work (exploration, retroperitoneal areas with or without biopsy(s).) and our spine surgeon report the corpectomy codes with no modifiers?

Answer:

The correct way to report this is as co-surgery. The orthopaedic surgeon and the general surgeon will both report the primary procedure as co-surgery, using the exact same CPT code with a 62 modifier. The approach to the spinal procedure is included in the definitive procedure, thus each surgeon is doing distinct separate procedures. If the tumor expands more than one segment, and the two surgeons continue to function as co-surgeons, they may report the appropriate add-on procedures as co-surgeons also.

For example:

63303-62 Vertebral corpectomy (vertebral body resection), partial or complete, for excision of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal or retroperitoneal approach

63308-62 each additional segment (List separately in addition to codes for single segment.