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Orthopedic Coding Alert

CPT Unveils New Arthroscopic Rotator Cuff Repair Code for 2003
CPT 2003 introduced three new arthroscopic surgery codes, including 29... Read more
Operative Report Examination:
How to Know When Fracture Care Is an Incident-To Service
Orthopedists need not personally cast a patient's fracture to report fracture care cod... Read more
Specialty Spotlight:
Hand Surgery: Dont Let Reimbursement Slip Through Your Fingers
Hand surgeons who perform surgical procedures on multiple digits should append the f... Read more
News Brief:
OIG to Scrutinize Bone Density Screenings,Incident-To Claims
Heads up, orthopedic coders: The U.S. Office of Inspector General (OIG) will be scruti... Read more
Know Your Insurers Bone Density Screening Rules
Most Medicare carriers require that patients have at least one of the following five c... Read more
News Brief:
Version of Incident-To Billing Now Allowed in Hospitals
Effective Oct. 25, 2002, CMS will allow incident-to billing for hospital inpatient, ... Read more
Reader Questions:
-59 Not Necessary for Knee Arthroscopy
Question: Every time our practice bills 27425 (Lateral retinacular release [any m... Read more
Reader Questions:
Shoulder Manipulation
Question: Our patient had an apparent scapulotho-racic dislocation (831.0x-831... Read more
Reader Questions:
Lumbar Disc Disease
Question: Are lumbar discogenic disease and lumbar disc disease coded as 722.10 (Lumb... Read more
Reader Questions:
Repicci Procedure
Question: Our orthopedist indicated that he performed a Repicci procedure and later to... Read more
Reader Questions:
Epidural Steroid Injection
Question: What is the appropriate code for an L2-3 intralaminar epidural steroid injec... Read more
Reader Questions:
Femoral Head Is Not Coded As Femur
Question: Is there a CPT code for resurfacing the femoral head? Someone recommended 27... Read more
Reader Questions:
Tendon Repair, Tumor Removal
Question: Our surgeon recently excised an extensive giant cell tumor of the tendon s... Read more
You Be the Coder:
DME Application
Test your coding knowledge. Determine how you would code this situation before looki... Read more
CCI 8.3:
Coding Three Knee Joint Compartments Is No Longer a Snap
The new edition of the Correct Coding Initiative (CCI), which took effect on Oct. 1,... Read more
Split X-Ray Components for SNF Patients
When billing for skilled nursing facility (SNF) patients who present to your orthope... Read more
Don't Let NCS Coding Get on Your Nerves
Coders can streamline nerve conduction study (NCS) claims by reporting multiple NC... Read more
Modifier of the Month:
Use Modifier -78 Only for Related Procedures
Orthopedists whose patients must return to the operating room for additional treatme... Read more
READER QUESTION:
Bankart Lesion Code
Question: Is there an ICD-9 code designated for a Bankart lesion? Te... Read more
READER QUESTION:
Shoulder Debridement
Question: According to the Correct Coding Initiative (CCI), 29822 (Arthroscopy, s... Read more
READER QUESTION:
Ulna and Tibia Fractures
Question: Which code should we use when reducing a distal ulna fracture? Denver Subsc... Read more
READER QUESTION:
Bilateral X-Rays
Question: Can we use modifier -50 (Bilateral procedure) with x-ray codes such as 735... Read more
READER QUESTION:
Polydactyl Thumb Removal
Question: Our hand surgeon performed a polydactyl removal of right and left thumbs (no... Read more
READER QUESTION:
Carpal Boss
Question: Is there a code for excision of carpal boss or spurringo carpometacarpal joi... Read more
READER QUESTION:
PA Performing Preoperative Exam
Question: For elective surgery, our physician assistant (PA) usually performs the hist... Read more
READER QUESTION:
Pin Removal
Question: In the September 2002 issue, you suggested that modifier -58 (Staged or... Read more
You Be the Coder:
Thermal Capsulorrhaphy With SLAPLesion
Test your coding knowledge. Determine how you would code this situation before looki... Read more
Draw Your Own Line to Differentiate Between Acute and Chronic Conditions
Because coders are often unable to find definitive guidelines for determining which co... Read more
Use E/MCodes for X-Ray Rereads for Proper Payment
Orthopedic practices that refer patients for x-rays should always record the x-ra... Read more
Consult These Guidelines When Billing Consultations
Contrary to what many coders believe, more than one physician can bill consultation ... Read more
Modifier of the Month:
Use Modifier -52 for Reduced Services
Just because you can't complete an orthopedic procedure doesn't mean you ... Read more
Reader Question:
Suture Removal
Question: How should we code for suture removal if we didn't perform the original surg... Read more
Reader Question:
New Trigger Point Codes
Question: This year, the new trigger point injection (TPI) codes were introduced (20... Read more
Reader Question:
SI Joint Injection
Question: Our orthopedist performed an SI joint injection without arthrography or fl... Read more
Reader Question:
Periacetabular Osteotomy
Question: How should we code a periacetabular osteotomy of the hip? Virginia Subscrib... Read more
Reader Question:
Multiple Finger Injections
Question: How should I bill Medicare when we do more than one finger injection on the ... Read more
Reader Question:
Injection and E/M
Question: When the doctor sees a new patient, evaluates his condition, and decides t... Read more
You Be the Coder:
Unicondylar TKR
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
Shoulder Surgery Primer:
Code Off the Cuff for RTC Repairs and SAD
" You may be tempted to report an unlisted-procedure code when orthop... Read more
Know When to Fight for Fluoro Reimbursement
Although many coders argue that fluoroscopy should never be billed separately from i... Read more
Modifier of the Month:
Modifiers -80 and -82 Aid Assistant Surgeon Claims
Orthopedic surgeons from the same practice often serve as one another's assistant su... Read more
CMS Announces New Aftercare V Codes
On June 20, CMS announced the ICD-9 code changes for 2003. The revisions mos... Read more
New 2003 ICD-9 Codes
Although Medicare will accept these codes beginning Oct. 1, carriers must still pr... Read more
Correction
The August 2002 Orthopedic Coding Alert featured a "Modifier of the Month" article reg... Read more
Reader Question:
Two Levels of Epidural
Question: Can we bill 62311 (Injection, single [not via indwelling catheter], not ... Read more
Reader Question:
Scoliosis Exams
Question: Our orthopedists often see children for scoliosis screenings. The doctor... Read more
Reader Question:
Pin Removal
Question: Can I charge for pin removal in the office following closed reduction and ... Read more
Reader Question:
Exercise Instruction
Question: What code should I use when the orthopedist teaches the patient exercises ... Read more
You Be the Coder:
Arthroscopic Wrist Excision
Test your coding knowledge. Determine how you would code this situation before looking... Read more
CCI Bundles Anesthesia,Injection Codes Into Orthopedic Procedures
" Version 8.2 of the national Correct Coding Initiative (CCI) took effect on July 1 and b... Read more
Beat the OIGto the Punch:
Benchmark Against CMS
Because U.S. Office of Inspector General (OIG) investigators review code utilizati... Read more
Compare Apples to Apples
Comparing your code use with CMS' statistics may not be completely accurate because th... Read more
Modifier of the Month:
Modifier -59 Versus -51: The Great Debate
Modifiers -59 (Distinct procedural service) and -51 (Multiple procedur... Read more
News Brief:
CMS Announces New Hyalgan Code
On June 11, CMS released program memorandum AB-02-082, introducing a new code for ... Read more
Reader Question:
Synvisc for Shoulders
Question: Is there any way that Medicare will reimburse us for a shoulder injection ... Read more
Reader Question:
Disability Evaluation
Question: In your July issue, you recommended using 99080 (Special reports s... Read more
Reader Question:
Referred Patients
Question: I work for an orthopedist who does not use any new patient CPT cod... Read more
Reader Question:
Sciatic Nerve Exploration
Question: Is there a CPT code to denote exploration of the sciatic nerve with releas... Read more
Reader Question:
Lidocaine for Peroneal Sural Nerve Block
Question: Our orthopedist documented a left peroneal sural nerve block. He indicates... Read more
Reader Question:
CTR With Flexor Tenosynovectomy
Question: One of our surgeons performed a carpal tunnel release and, as a separate p... Read more
You Be the Coder:
Thumb Arthroplasty
Test your coding knowledge. Determine how you would code this situation before looking... Read more
Dont Get out of Joint When Coding Lisfranc Fracture-Dislocations
" Fracture-dislocations of the tarsometatarsal joint nicknamed Lisfranc"" after a field... Read more
Harvest Reimbursement for Allograft Procedures
Orthopedic practices that use allograft should be sure to avoid the CP... Read more
Modifier of the Month:
Modifier -55 Allows Separate Billing During Global Period
Orthopedists who perform postoperative care for patients whose surgeries have been per... Read more
Take the Guesswork Out of Diagnosis Coding
When searching for a diagnosis code to list on a claim when no definitive ICD-9 code e... Read more
When to Use Signs and Symptoms Codes
Symptoms, Signs, and Ill-Defined Conditions codes (780-799.9), listed in section 16 of... Read more
Reader Question:
ER Evaluation
Question: Can we use the 99211-99215 series of codes for ER visits? My insurer denies ... Read more
Reader Question:
Bivalving a Cast
Question: Is there a CPT code for "bivalving" an arm cast? New Jersey Subscriber Ans... Read more
Reader Question:
Antibiotic Bead Insertion
Question: How should we code for windowing the navicular and cuboid bones, with implan... Read more
Reader Question:
Disability Forms
Question: Is there a CPT code we can use when the orthopedist fills out disability o... Read more
Reader Question:
Iliotibial Band Release
Question: Our orthopedist repaired an iliotibial band release for iliotibial friction ... Read more
Reader Question:
Compartment Syndrome
Question: Is there a CPT code we can bill for measuring the pressure in the compartmen... Read more
Reader Question:
X-Ray Interpretation
Question: We send our patients to an outside lab for x-rays, but we interpret the fi... Read more
Reader Question:
PA Seeing New Patients
Question: We have a physician assistant on staff. Can he use the E/M codes to treat ne... Read more
Reader Question:
Tendon Repair
" Question: The orthopedist's operative report for a patient with a pe... Read more
Reader Question:
Plantar Fascia Release
Question: Which code should we bill when the orthopedist performs a plantar fascia relea... Read more
You Be the Coder:
Supraspinatus Repair
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
Understand the Building Blocks of Spinal Reconstruction Surgery Coding
" When you comprehend the large number and complexity of terms associated with spinal an... Read more
Stay Alert to Opportunities to Code for Conscious Sedation
Orthopedists and their coders often ask about the legitimacy of billing for conscious ... Read more
The Anatomy of the Spine
The human spine is divided into three major sections: cervical, thoracic and lumbar. T... Read more
Modifier of the Month:
Use -32 for Mandated Services
Modifier -32 (Mandated services) describes procedures or services required b... Read more
Correction:
Correction:
The May 2002 "Modifier of the Month" column regarding modifier -77 should have... Read more
Reader Question:
Previous Hip Procedure
Question: The patient had an acetabuloplasty with resection of the femoral head. While... Read more
Reader Question:
Open Reduction
Question: Our surgeon spent 10-15 minutes on a patient, attempting a closed reduction ... Read more
Reader Question:
Pain Catheter
Question: How should we code for the insertion of a pain catheter? Because the cathe... Read more
Reader Question:
Perilunate Dislocation
Question: The physician performed an open reduction and pinning of a perilunate disloc... Read more
Reader Question:
Consultations
Question: I've been submitting 99241-99245 when one of my surgeons does a consultation... Read more
You Be the Coder:
Status Code Issue
Test your coding knowledge. Determine how you would code this situation before looking a... Read more
AMA,AAOS Offer Advice for Using New Codes for Bankart and SLAP Lesion Repairs
Latest Question on ICD-9 and CPT Code for Bankart Lesion from S... Read more
Meet the Coding Challenges of ACL Reconstruction and Revision
" There are several methods by which a physician can achieve anterior cruciate ligament (... Read more
Use MDM to Achieve Accurate E/M Coding
Coding E/M visits in the orthopedic setting can be a struggle for even the most savv... Read more
Clarification:
Billing for Casts,Strapping and Splinting
Two recent articles in Orthopedic Coding Alert contained advice on coding and billing ... Read more
Modifier of the Month:
Use -77 When Two Physicians Perform Same Service
Modifier -77 (Repeat procedure by another physician) is reported when another physic... Read more
Reader Question:
Bossing
Question: I have an operative report for an excision of "bossing of the dorsal aspect of... Read more
Reader Question:
Akin Procedure
Question: One of the surgeons in my practice coded an Akin procedure as 28310, but CPT... Read more
Reader Question:
Category III Codes
Question: Should I be using code 0014T (Meniscal transplantation, medial or lateral, k... Read more
Reader Question:
Botox Injections
Question: We occasionally use Botox for trigger point injections for pain management. My... Read more
You Be the Coder:
Multiple Knee Codes
Test your coding knowledge. Determine how you would code this situation before looking... Read more
AAOS Releases Bundling Guidelines for New CPT Surgical Codes
CPT 2002 includes several new musculoskeletal codes that the Correct C... Read more
Fingers and Toes:
Count on Modifiers When Billing Multiple Procedures
" Proper coding for procedures performed on mult... Read more
Modifier of the Month:
Use -76 When One Physician Repeats Procedure,X-Ray Study
Modifier -76 (Repeat procedure by same physician) is appended when the same procedur... Read more
Correction:
X-Ray Coding and Emergency Department Visit
Component, Location Shed Light on X-Ray Coding, appearing in Orthopedic Coding Alert Febru... Read more
Reader Question:
Lateral and Medial Compartments
Question: Our physician performed knee arthroscopy (29879) in the lateral and medial com... Read more
Reader Question:
Impingement of Ankle
Question: How should we code "impingement of the ankle"? Hawaii Subscriber Answer: Im... Read more
Reader Question:
E/M,Admission on Same Day
Question: How should I bill an E/M visit in the office on the same date as a hospital ... Read more
Reader Question:
X-Rays Performed in the Office
Question: We own our x-ray equipment and take all our x-rays in the office. The x-ray ... Read more
Reader Question:
Fracture Coding
Question: The patient had a comminuted surgical neck fracture with displaced humeral... Read more
Reader Question:
Hardware Removal
Question: What combination of V and numeric ICD-9 codes should I use for internal har... Read more
You Be the Coder:
Two Surgeons, Distinct Services
Test your coding knowledge. Determine how you would code this situation before looki... Read more
Closed Fractures:
Accurate Coding of Diagnosis, Treatment Essential to Ethical Reimbursement
Closed fractures can present mind-boggling coding challenges, with many different typ... Read more
Knee Injections, E/M Services:
Diagnosis, Intent and Modifier Determine Coding Possibilities
Orthopedic coders accustomed to billing for therapeutic injection in the knee (a common ... Read more
Simplify Coding of Starred Procedures with E/M Services
Orthopedists may be familiar with "starred" procedures, so named because the CPT manual ... Read more
News Brief:
CCI Recalls Arthroscopy Modifier Indicator Edit
A coding edit in Correct Coding Initiative version 8.0 (CCI 8.0), in effect Jan. 1-March... Read more
Reader Question:
Tibial Stripping
Question: How should I code for a posteromedial tibial periosteal stripping that I did in ... Read more
Reader Question:
Rotator Cuff Tear
Question: Our surgeon reports that he did an open lateral deltoid splitting approach for a... Read more
Reader Question:
Bankart and SLAP Lesions
Question: How should I code repair of a Bankart lesion and a SLAP lesion? Texas Subscrib... Read more
Reader Question:
Modifier and E/M Visits
Question: My physician is adding modifier -57 to all E/M visits where the decision for s... Read more
Reader Question:
Scar Revision
Question: How should I code a scar revision of the forearm during which the surgeon cut ou... Read more
Reader Question:
Casting and Splinting
Question: I know casting is included in the fracture repair codes, but what about strapp... Read more
Reader Question:
One Incision
Question: Our surgeon performed tenosynovectomy of flexor hallucis longus, tenosynovectomy... Read more
You Be the Coder:
Dislocated Hip Prosthesis
Test your coding knowledge.  Determine how you would code this situation before loo... Read more
Elementary Coding:
Overcome the Challenges of Playground Accidents, Childhood Sports Injuries
An orthopedic injury can seriously impact a child's physical maturity. Coding for thes... Read more
Component, Location Shed Light on X-Ray Coding
Orthopedists make routine use of x-rays as part of good healthcare practice, sending... Read more
News Brief:
New Medicare Code Identifies Pain Management Specialists
On Jan. 1, 2002, CMS assigned a new specialty code for physicians who specialize in pain m... Read more
CCI Bundling Uniplane, Fracture Codes Contradicts Guidelines
Correct Coding Initiative 8.0, in effect Jan. 1-March 31, 2002, includes more than 200 ref... Read more
Reader Question:
Consultation and Fracture
Question: Our orthopedic surgeon was called to the emergency room to treat a patient. Afte... Read more
Reader Question:
Thermal Debridement
Question: Our physician performed an arthroscopic radiofrequency thermal debriding of unst... Read more
Reader Question:
Synvisc/Hyalgan Injections
Question: For Synvisc/Hyalgan injections, we usually have to order the medication after pr... Read more
Reader Question:
Necrotic Hip
Question: Our physician diagnosed a patient in the office with a necrotic hip pressure u... Read more
Reader Question:
Partial Hip Replacement
Question: Our hip surgeon did a revision of a total hip replacement, replacing the aceta... Read more
Reader Question:
C3-4 Laminoplasty
Question: What is the best code to report a C3-4 laminoplasty? Missouri Subscriber  ... Read more
Reader Question:
Knee Arthroscopy
Question: Can 29879 be reported with 29877 if the two procedures are performed in differ... Read more
Reader Question:
Knee Arthroplasty Follow-Up
Question: How should we use the V code when reporting treatment of a patient for arthritis... Read more
You Be the Coder:
Electrothermal Arthroscopy
Test your coding knowledge.  Determine how you would code this situation before loo... Read more
Its Never Too Late To Learn Proper Diagnostic Information for Coding Late Effects
Coding for late effects of traumatic injuries is often poorly understo... Read more
AMA/CPT Defines the Global Surgical Package
In a year that has seen the AMA move toward greater specificity in its codes and code ... Read more
Reader Question:
Impairment Rating
Question: What code should I use when the physician does an impairment rating?Colorado Sub... Read more
Reader Question:
Component of THR
Question: An orthopedic surgeon performs a revision of the acetabular component of a total... Read more
Reader Question:
Co-Surgeons
Question: One surgeon from our practice performed an open reduction with internal fixati... Read more
Reader Question:
Arthroscopy Coding
Question: The operative report lists chondroplasty of the humeral head chondral frac... Read more
Reader Question:
Nerve Conduction Studies in Office
Question: We've started to perform nerve conduction studies (NCS) in our office. The equ... Read more
Reader Question:
Return to the OR
Question: What diagnostic code do I use for the loss of reduction or fixation on a fractur... Read more
Reader Question:
Pain Pump
Question: I have been using 37202 (transcatheter therapy, infusion other than for thromb... Read more
Reader Question:
Marcaine Payment
Question: I am having difficulty getting paid for Marcaine. We use the unlisted HCPCS ... Read more
Reader Question:
Billing for a Medicare Patient
Question: Should 20936 and 20937 be billed together with modifier -59? This is a Medicare ... Read more
Reader Question:
Closed Reduction for Multiple Fracture
Question: The physician performed a closed reduction of a fracture of both bones and a per... Read more
Reader Question:
Radiofrequency
Question: My physician performed an arthroscopic radiofrequency thermal debriding of uns... Read more
Reader Question:
Carpal Scaphoid
Question: My surgeon is performing a 25628 (open treatment of carpal scaphoid [navicular... Read more
Reader Question:
Open Reduction
Question: My surgeon spent 10 to 15 minutes on a patient, attempting a closed reduction ... Read more
You Be the Coder:
Fracture Coding
Test your coding knowledge.  Determine how you would code this situation before... Read more