The Orthopaedic Coding Coach 2012 Archives

We are billing 63030 for a discectomy but the spine surgeon wants to also bill for repairing the dura. The operative note states an “incidental durotomy” was made. Can we also bill 63710 for the dura repair?

No. Repair of an intraoperative complication such as this is included in the global surgical package for the primary procedure, 63030, and not be separately billed by the spine surgeon.

Our hand surgeon will begin treating Dupuytren’s contractures this year using Collagenase to inject the cords. I see there is a new CPT code for the injection and the manipulation and understand the definitions. Is modifier 58, staged procedure, the correct modifier to append to the manipulation at the second visit?

Great job on thinking ahead! The good news, is that the injection code, 20527 (Injection, enzyme (e.g., collagenase), palmar fascial cord (i.e., Dupuytren's contracture) does not have a global period. The manipulation the next day is reported with CPT code 26341 (Manipulation, palmar fascial cord (i.e., Dupuytren’s cord), post enzyme injection (e.g., collagenase), single cord) and no modifier is required.

I am reading an operative note and the surgeon dictated in the title, “arthroscopic medial resection of the clavicle.” In his operative note he states, “1.5 cm of the clavicle was excised and the remaining medial section underwent smoothing.” Can you provide us advice on how to code this procedure?

Based on the documentation presented, the correct code is CPT code 29824, Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)

There is no CPT code for the work associated with the “smoothing of the medial section.”

Our surgeon performed a sacroiliac joint fusion using a new approach.   His approach is documented as what appears to be percutaneous, and he wants to report 27280 for the fusion, and then also report codes for SSEP monitoring and fluoroscopic guidance.  His question is if this is the correct way to report the procedure.

Thanks for your follow-up in sending the operative note for review.  The documentation supports an approach using image guidance (fluoroscopy), thus the best way to code this is to report an unlisted code.  The intraoperative physiologic monitoring is inclusive as is the fluoroscopic guidance for the approach.

Our surgeon was called to the OR to perform and intraoperative consultation. How do we report this service?

The service will be dependent on the payor. Report 9925X Inpatient Consultation if the payor still recognizes consultation services. Report 9922x or 9923x to Medicare based on the documentation.

Our surgeon performed a right medial meniscus repair and a tri-compartmental chondroplasty on a 45 year-old-female. Can the surgeon report the chondroplasty and the meniscal repair or only the meniscal repair?

Thank you for your inquiry. Effective 1/1/12, CPT revised the meniscectomy codes (29880 and 29881) to include a chondroplasty performed in the same knee, same session. The code changes did not affect the meniscal repair codes.
The correct way to report this case according to the CPT rules is to report 29882 and 29877-59 for the medial meniscal repair (29882) and 29877-59 for the chondroplasty in the other two compartments (not medial). Medicare still requires the G code; report 29882 and G0289 to Medicare.

Our surgeon performed an anterior interbody fusion at L3-5 and then turned the patient over to perform a posterolateral fusion at the same levels, L3-5. Do I report the new codes 22633 and 22634 for the fusion part of this procedure?

This is a great question! The new combine code(s) describe posterior procedures only. Your scenario is reported with the anterior interbody fusion codes (22558 and 22585) and then the posterior codes are 22612 and 22614. Remember to append modifier 62 (two surgeons) to the anterior interbody fusion if the approach was performed by the general or vascular surgeon.

We are trying to prepare our coding templates for the new year. One of the surgeries our surgeons perform on a regular basis includes a combined posterolateral fusion and posterior interbody fusion. If the surgeon performs this procedure at L3-4, and L4-5, how do we code for the fusion? We are good on how to report the instrumentation and grafts.

Thanks for your inquiry and kudos to the team for ensuring correct coding and compliance to start the New Year. The code changes effective 1/1/12 require the posterolateral and posterior interbody fusion(s) to be reported with the new combination code when performed during the same operative session. Because the surgeon performed both posterior fusions at the same levels, the surgeon reports 22633 and 22634 for the combined posterolateral and posterior interbody fusions at L3-4 (22633) and L4-5 (22634).

CPT defines 22633 as Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and level; lumbar
22634 is reported for each additional interspace and is an add-on code to CPT code 22633.