The Orthopaedic Coding Coach Archives

Question:

Our surgeon recently performed a total hip resurfacing procedure. How do we report this?

Answer: 

The correct code for the total hip resurfacing procedure is CPT code 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft.

Question:  

Our surgeon dictated that he performed a medial femoral chondroplasty and a medial meniscectomy.  Can I report the chondroplasty in addition to the meniscectomy?

Question:

When billing total knees (27447) for a patient when two doctors each work on a different knee, should we bill each doctor’s surgery on a different claim with a right modifier for one doctor and a left modifier for the other doctor?  Or should we use the 50 modifier and the 62 modifier with each doctor billing on a separate claim?

Answer:  

When the CPT rules changed several years ago, Medicare created a policy statement that the correct way to report these services was as co-surgeons.  The following statement is an excerpt from the National Medicare Policy:

“Under some circumstances, the individual skills of two or more surgeons are required to perform surgery on the same patient during the same operative session. This may be required because of the complex nature of the procedure(s) and/or the patient’s condition. In these cases, the additional physicians are not acting as assistants-at-surgery.”

Billing Instructions

The following billing procedures apply when billing for a surgical procedure or procedures that required the use of two surgeons or a team of surgeons:

• If two surgeons (each in a different specialty) are required to perform a specific procedure, each surgeon bills for the procedure with a modifier “-62.” Co-surgery also refers to surgical procedures involving two surgeons performing the parts of the procedure simultaneously, i.e., heart transplant or bilateral knee replacements. Documentation of the medical necessity for two surgeons is required for certain services identified in the MFSDB. (See §40.8.C.5.).

“For co-surgeons (modifier 62), the fee schedule amount applicable to the payment for each co-surgeon is 62.5 percent of the global surgery fee schedule amount.”

Question:

How do you code for a corocoidplasty or coracoplasty? Our physicians are performing it arthroscopically at the same time as other shoulder procedures.

Answer:

There is no CPT code for this procedure, thus you would report the unlisted code 29999.

Question:

Our physician documented that she had to manipulate/move a fixation device. The patient is outside the global period. Is there a code for this work?

Answer:

CPT code 20693, Adjustment or revision of external fixation system requiring anesthesia (e.g., new pin(s) or wire(s) and/or new ring(s) or bar(s)), is used if the revision/adjustment is performed in the operating room under anesthesia. If the procedure is performed in the office, report an established patient visit 9921x.

Question:

Does an intermediate repair "have to" include debridement of some type? For example, according to CPT the repairs are listed with the following references:

Simple repair = no debridement

Intermediate repair = requires debridement

Complex repair = requires debridement

Am I understanding this correctly?

Answer:

While a wound may require debridement of tissue (skin, subcutaneous tissue, muscle/fascia or bone), it is not a requirement to report the appropriate repair code. The reference to the debridement in the repair code means that the debridement is an inclusive or integral part of the procedure and not reported separately in addition to the repair code. CPT gives specific guidelines on which repair code is appropriate based on whether debridement is performed and the type of repair.

Question:

What is the CPT code for a platelet rich plasma injection? It is a platelet tissue graft.

Answer:

There is no CPT code for this procedure, as it is included in the surgical package and not separately reportable. The codes from the plasmapheresis section of CPT do not describe this procedure.

Question:

Our surgeon submitted the following CPT codes to the commercial insurance company:

22554

22845

63075

22855

The insurance company denied CPT codes 22845 and 22855. They re-coded this to 22849 and paid. Why would they re-code these to this CPT?

Answer:

While we never like to see a payor change CPT codes, based on how this was submitted, the payor may be right. There are no modifiers on the CPT codes, thus the payor assumed removal and reinsertion at the same level. If this is correct, then 22849 is the correct CPT code. If instrumentation was removed at one level and new instrumentation was placed at a new level, the submitted codes are correct, but modifier 59 would be appended to CPT code 22845 to indicate new instrumentation at a new level.

Also, review the fee scheduled for these procedures. CPT code 63075 has higher RVUs and should be listed first on the claim form as the highest valued procedure and CPT code 22554 would be listed second with a modifier 51.

Question:

We have a Medicare patient who presented to the ER with a post op infection during the global period of his surgical procedure. Our physician was called to the ER to see this patient and submitted charges for the I&D he performed in the ER. I am not sure I can report these services. Is this I&D separately reportable or not?

Answer:

No, the service is not separately billable according to Medicare’s definition of the global surgical package. To bill for the treatment of a complication during the global period, the service must be performed in the OR, ASC, endoscopy/laser suite, or ICU if patient is critically ill and is unable to be transported to the OR. The ER, holding area, PAR, non-certified procedure room does not constitute an approved location.

Question:

Our surgeon documented a minimal incision total hip arthroplasty. How do I code this procedure?

Answer:

Whether the surgeon makes a standard incision or performs the surgery with a minimal incision approach, the procedure is reported with CPT code 27130. A modifier 22 would not be appended to the code just because the minimal incision approach was taken.

Question:

I was recently told by another office that if a patient brings in their films and my orthopaedic physician reads them even though there is a printed reading that we can bill for that interpretation. Can we bill 73564-26 for re-reading those films?

Answer:

No, the review of the x-rays during the physicians office visit is included in the data review section of the Medical Decision Making component of the E&M visit. Since the x-rays have already been interpreted, your physicians review is not separately billable as a separate interpretation.