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Orthopedic Coding Alert

CPT® 2013 Update:
4 New Codes Upgrade Your Coding for Revision Arthroplasty of Shoulder And Elbow
Tip: Determine if one or both components of joint are revised.2013 brings you a new array ... Read more
Coding Strategies:
Reporting Multiple Fracture Repairs? Recast Your Claims With These Tips
Key: Watch the order and select the right modifiers.Miscoding when your surgeon in the ED ... Read more
CCI Edits 18.3:
Beware Wound Repair Bundles In Musculoskeletal Procedures
Red flag: You may be wrong to bill the incisions and closures.CCI edits 18.3 bundle the co... Read more
Reader Question:
Fall Back Upon 27360 for One or More Bones
Question: Can we report code 27360 (Partial excision [craterization, saucerization, or dia... Read more
Reader Question:
Check Your Codes for Charcot's Arthropathy
Question: What is the correct code for Charcot's arthropathy when there is no documentatio... Read more
Reader Question:
Look For Bone and Tendon Replacement in Failed Quadriceps Mechanism
Question: Our surgeon did a right knee quadriceps reconstruction and inserted a new tibial... Read more
Reader Question:
Code for Removal and Insertion of Hip Prosthesis
Question: Our surgeon did a debridement and removal of arthroplasty in a patient who was d... Read more
Reader Question:
Rongeur and Curette Do Not Imply Osteotomy
Question: Our surgeon did an open repair and internal fixation with Vitoss bone graft for ... Read more
You Be the Coder:
Relate Guyon's Decompression to Ulnar Nerve Release
Question: In a patient with left wrist pisiform-triquetral arthritis (pisotriquetral ... Read more
Coding Tips:
Perfect Your Shoulder Osteomyelitis Treatment Payment With This Advice
Structure handled and not extent of excision is important when reporting for chronic osteo... Read more
CPT® 2013:
Check 9 New Unlisted Procedure Codes in 2013
This article has been removed due to incorrect information. We apologize for the error. ... Read more
Coding Strategies:
Follow These Steps To Gain Clarity And Confidence In Reporting Pressure Sore Treatment
Extent of debridement and location of the pressure are your main guide.When reporting pres... Read more
2 Tips Simplify Your Choice of Flaps
Use this advice to help you distinguish between skin and myocutaneous flaps. 1. Look for h... Read more
Reader Question:
Report OATS as Unlisted
Question: In a patient diagnosed with right ankle osteochondritis dessicans (OCD), our sur... Read more
Reader Question:
Check Size of Lipoma of Sinus Tarsi
Question: Our surgeon did an open excision of a lipomatosis nodule of the sinus tarsi on b... Read more
Reader Question:
Each Step is Important in Shoulder Revision
Question: How would you code a right reverse total shoulder arthroplasty revision to hem... Read more
Reader Question:
Discretely Report Each Step in Shoulder Surgery
Question: Our surgeon did the following procedures:Left shoulder arthroscopy with subacrom... Read more
Reader Question:
Do Not Treat Accessory Soleus as Soft Tissue Tumor
Question: How do we code for excision of accessory soleus muscle in leg? Can we report thi... Read more
Reader Question:
Turn to Unlisted Procedure Code for MTP Instability
Question: For a patient presenting with instability in the right second metatarsophalangea... Read more
You Be the Coder:
You Can Bill Together For Tenotomy and Debridement
Question: Is it true that we cannot bill 23405 (Tenotomy, shoulder area; single tendon) wi... Read more
Coding Tips:
Does Your Shoulder Incision And Drainage Coding Make the Grade?
Hint: Get to the right code by confirming what your surgeon drained.Your surgeon may perfo... Read more
ICD 10 Update:
Zero in on These Specifics For Neck of Femur Fractures
Best bet: Confirm side for closed fractures, side and type for open fractures. ICD-9 g... Read more
Coding Strategies:
Take These Steps to Relieve The Pressures Of Reporting Pressure Ulcers
Tip: Confirm ulcer location and any procedures. Pressure sores or ulcers are a common find... Read more
Reader Question:
Distinguish Pathological and Traumatic Fractures
Question: A patient with metastatic carcinoma developed an anterior cord injury along wi... Read more
Reader Question:
Report Tendon Repair of Glutei as Unlisted
Question: Our surgeon did a tendon repair of the gluteus minimus and gluteus medius? What ... Read more
Reader Question:
Removal of External Fixator Is Not Inclusive In ORIF
Question: Our surgeon did an external fixator removal and ORIF of distal tibia.The diagnos... Read more
Reader Question:
Target 27372 for Foreign Body Removal in Knee
Question: Our surgeon did a foreign body removal in the knee. The procedure details are as... Read more
Reader Question:
Keep A Watch on Incisions For Finger Nodules
Question: Our surgeon excised mass in the finger. The procedure is as follows: Excision of... Read more
Reader Question:
Count Each Tendon Repaired in Finger
Question: In a patient who was diagnosed a zone 1 laceration of the left index finger, our... Read more
Reader Question:
Check the Bundle for Chondroplasty
Question: How does one code for a medial meniscectomy, synovectomy of medial, lateral, and... Read more
You Be the Coder:
Confirm Prosthesis for Patellar Arthroplasty
Question: Our surgeon did a patellar resurfacing in an outpatient facility. Is it correct ... Read more
Coding Case:
Dig Deep To Nail The Right Code For Subacromial Calcific Tendinitis
Curettage and tendon repair are inclusive to 23000. When your surgeon removes calcific de... Read more
Coding Tip:
Turn To Soft Tissue Tumor Codes for Lipoma Excisions
Determine the location, depth, and size to select the right code. When reporting lipoma ... Read more
ICD-10 Update:
Get Specific For Digits in Closed Fracture of Hand Phalanges
Select code after confirming if fracture is displaced or nondisplaced. When reporting th... Read more
Reader Question:
Quadriceps Suture includes Patellar Realignment
Question: Our surgeon does quadriceps tendon reconstruction with patellar realignment. T... Read more
Reader Question:
Do Not Report Resinertion, Removal with 22840
Question: Our spine surgeon removed instrumentation from L4-S1 and then placed new instru... Read more
Reader Question:
Designate Sesamoiditis as Other Disorder
Question: What is the ICD-9 code for sesamoiditis of the foot? Pennsylvania Subscriber An... Read more
Reader Question:
Count Interspaces to Report Units of +22851, +22552
Question: When coding 22851 (Application of intervertebral biomechanical device[s] [e.g.,... Read more
Reader Question:
Count Any Two Malleoli as Bimalleolar
Question: Can you please help us to report the following procedure? DIAGNOSES: Fracture d... Read more
Reader Question:
Be Discrete in Tendon Transfer, Lengthening or Shortening
Question: Can we report codes 26498 (Transfer of tendon to restore intrinsic function; al... Read more
You Be the Coder:
Check Extent of Erosion in Tumor Excision
Question: Our surgeon did a planned release of an A-1 pulley with excision mass over DIP ... Read more
Coding Case:
Advice Helps You Ace Your Tenotomy With Hammertoe Correction Reporting
Make sure you're using the correct modifier and that you check with your payor. Th... Read more
Accurately Identify a Separate Procedure
Medicare has clear guidelines for separate procedure.Having clear documentation of the pro... Read more
CCI Edits 18.2:
Ensure You Separately Identify Each Hip Joint Procedure
Arthroscopy gets column 2 status with hip procedures.CCI edits 18.2 effective July 1 to Se... Read more
Coding Tips:
Follow These Tips To Improve Your Add-on Code Success
Beware of modifier 51 for add-on procedures.Add-on codes can augment your payment for addi... Read more
Reader Question:
Consider Fracture Blisters As Seroma
Question: The patient had fracture repair and returned with several fracture blisters. &nb... Read more
Reader Question:
Think Twice for Disposable Pumps
Question: Can we bill for supplying a patient with elastomer, coban? This is done on a 2nd... Read more
Reader Question:
Do Not Report Debridement with 27301
Question: Please advise on the correct codes to use for the scenario below."We did an inci... Read more
Reader Question:
Turn to 11981 for Antibiotic Nail
Question: Our doctor needed to treat osteomyelitis while the patient had an active fractur... Read more
Reader Question:
Refrain From Reporting 29700 And 29075 Together
Question: Would it be appropriate to report cast removal using code 29700 (Removal or bi... Read more
You Be the Coder:
Report Repair of Each Tendon
Question: Can you help with this scenario? The operative note has the following for diagno... Read more
Coding Tips:
Augment Your Arthroscopic Reporting Accuracy With These Tips
Know where the arthroscopically aided procedures override the open approach. When your... Read more
Check Out This Case Study for Tibial Spine Fracture Repair
Use our operative note example below to guide your code selection for an arthroscopic repa... Read more
ICD-10 Update:
Confirm Site Before Assigning Juvenile Osteochondritis In ICD-10
Anatomical location is your guiding factor.Once ICD-10 is adopted, you'll need to ensure t... Read more
CCI Update:
CCI 18.1 Update: Edits Alter Your Selective Catheter Placement With Vessel Repair Reporting
Watch for the new compression codes and manipulation.Certain CPT® 2012 codes that do... Read more
Reader Question:
Look for Specific Code for Gerdy's Tubercle
Question: How do we code an injection of Gerdy's tubercle? Do we report it as trigger poin... Read more
Reader Question:
Pick Up Pelvis Fracture Codes
Question: How do we report a fracture of the sacroiliac joint and ilium that the patient s... Read more
Reader Question:
Consider Plastic Deformity as Closed Fracture
Question: We need an ICD-9 code for plastic deformation of the radial and ulnar shaft... Read more
Reader Question:
Ascertain Clean Tumor Margins To Report Radical Resection
Question: Below is a part of the operative note recorded by our surgeon."The osteotome was... Read more
Reader Question:
Designate Bone Marrow Aspiration with Subtalar Arthrodesis
Question: Our foot surgeon is performing a subtalar arthrodesis 28725 (Arthrodesis; subtal... Read more
Reader Question:
Check for Bundle in 27472 And 13121
Question: Please confirm if 27472 (Repair, nonunion or malunion, femur, distal to head and... Read more
Reader Question:
Nix Search for Pretibial Bursectomy Code
Question: How do we report pretibial bursectomy?New York SubscriberAnswer: Bursectomy of k... Read more
Reader Question:
Do Not Always Claim the Hospital Admission
Question: How would you handle a hospital admission during the post operative period as fa... Read more
You Be the Coder:
Tumor Resection and Arthroplasty Can Be Done Together
Question: Are codes 23220 (Radical resection of tumor, proximal humerus) and 23472 (Arthro... Read more
Coding Strategies:
Apply These Secrets To Success for Arthroscopic Chondroplasty, Loose Body Removal Claims
Tip: Don't bill chondral debridement with meniscectomy or foreign body removal.When billin... Read more
Coding Tips:
Recalculate Your Shoulder Decompression Pay for 29826 With This Advice
RVU decreases by 14.24 but remains higher than the 50% multiple procedure reduction.Now th... Read more
NCCI Edits 18.1:
Edits Change Your Spine Procedure Options
Append modifiers to grafts, open procedure, fracture reduction, and arthrodesis with poste... Read more
Reader Question:
Reach for Correct Antibiotic Nails Code
Question: How can we bill for placement of an antibiotic nail for osteomyelitis of the tib... Read more
Reader Question:
Do Not Overlook Acetabular Revision in Total Hip Arthroplasty
Question: Our surgeon made a diagnosis of 'failed left total hip arthroplasty with aseptic... Read more
Reader Question:
Do Not Append Modifiers to Subacromial Decompression
Question: How do we code for scope with debridement of bicipital tendon and anterior labra... Read more
Reader Question:
You Have a Specific Code for Intramedullary Nail
Question: Can you please help us to report the following procedure that our surgeon did:Di... Read more
Reader Question:
Bill Separate Incision for Syndesmosis Repair
Question: Our surgeon did the following procedure:Removal of internal fixation, right ankl... Read more
You Be the Coder:
Apply Latest Edits to Avoid Denials in Shoulder Arthroscopy
Question:Our surgeon did the following operative procedures:1. Arthroscopic subacromial de... Read more
Coding Strategies:
Code Arthroscopic Chondroplasty, Loose Body Removal With Confidence
Compartment, incision, size of foreign body are your guides.Coding chondroplasties with pr... Read more
Policy Scoop:
Here's More on Reporting 29874 With 29881 and 29880
The "American Academy of Orthopedic Surgeons (AAOS) still advocates you report code 29874 ... Read more
Coding Tips:
Test Your +29826 Skills With 3 Common Situations
Look for other open, arthroscopic procedures and confirm with payers.Having a little extra... Read more
ICD-10 Update:
ICD-10 Gets Specific For Diastasis Of Muscle
Cause, not site guide you to the right code.You can expect ICD-10 to bring lots of changes... Read more
Reader Question:
Independently Report the Labral Repair and Ostepohyte Removal in Hip
Question: Our surgeon repaired a hip labrum tear along with femoral neck osteophyte remova... Read more
Reader Question:
Turn To Open Procedure Code For Nonunion Repair of Acromion
Question: Can someone assist me with a code for nonunion repair of acromion?Florida Subscr... Read more
Reader Question:
Bill Together For Microfracture Chondroplasty and Chondroplasty
Question: Our surgeon did a microfracture chondroplasty in the medial compartment and perf... Read more
Reader Question:
Be Specific With 27385 for Quadriceps Reconstruction
Question: Our surgeon is going to perform a Quadriceps tendon reconstruction in the knee... Read more
Reader Question:
Report for Laminectomy and Arthrodesis at Each Spinal Level
Question: Our surgeon did the following procedures: 1. L5 revision laminectomy  ... Read more
Reader Question:
Mallet Finger Has an Easy Choice
Question: What diagnosis code do we report for a mallet finger? How do we report if the pe... Read more
Reader Question:
Look At Size for Calcaneal Graft
Question: Our surgeon obtained a bone graft from the lateral wall of the calcaneus.  ... Read more
Reader Question:
Turn To Unlisted Code for Notchplasty
Question: Our surgeon does the following procedures:1. Lateral & medial meniscectomy2.... Read more
Reader Question:
Confirm Malunion for Distal Fibular ORIF
Question: For a patient diagnosed with status post open reduction internal fixation right ... Read more
You Be the Coder:
Report Staged Revisions in Knee
Question: Our patient had a failed arthroscopic ACL reconstruction.  Staged revisio... Read more
Coding Tips:
Update Your 29826 Use To Reflect Add-On Status in 2012
Turn to codes for arthroscopic debridement when reporting only arthroscopic subacromial de... Read more
ICD-10 Update:
You'll Need to Be More Specific With Muscle and Connective Tissue Disorders When ICD-10 Hits
Hint: Pay attention to the site of involvement. When you're coding for ligament disorders,... Read more
CPT®2012 Update:
Capture Radiological Supervision With Vertebroplasties: Here's How
You can report the professional component for your surgeon's services.If your surgeon perf... Read more
Reader Question:
Report the Tendon Repair in an Arthroscopic Meniscectomy
Question: Our surgeon performed a partial lateral meniscectomy and repaired the popliteus ... Read more
Reader Question:
Arrange Follow-Up with Original Surgeon
Question: We have taken over post operative care on a patient who had surgery from anoth... Read more
Reader Question:
Turn to Unlisted Code for Contracture Procedure in Toe
Question: Our surgeon documented the following:Diagnosis: 2nd Metatarsophalangeal stiffnes... Read more
Reader Question:
Select Code for Tenolysis of Biceps Done in Scope Surgery
Question: How can we code an open tenolysis of biceps tendon done during a scope surgery? ... Read more
Reader Question:
Know the Bundling of Adductor Tenotomy and Total Hip
Question: Our surgeon performed a conversion of hemiarthroplasty to a total hip but only n... Read more
Reader Question:
29826 is no longer a standalone code
Question: Our surgeon's op note reads as follows:"Camera was inserted. Examination of the ... Read more
You Be the Coder:
Repair of Coracoclavicular Ligament is Inclusive in 23550
Question: If our surgeon performed an ORIF for a distal clavicle dislocation and also... Read more
Coding Tactics:
Perfect Your Total Hip Replacement Reporting With These Tips
Never skip the underlying cause, infections, or dislocations.Appropriately capturing all y... Read more
ICD-10 Update:
Side, Site Guide Your Myositis Code Choices in 2013
Calcification and ossification location matters in ICD-10.Myositis coding can be challengi... Read more
CPT®2012 Update:
Ace Bone Biopsies With Vertebroplasties: Here's The Scoop
Locate the levels for primary procedure and biopsy.If your surgeon performed a bone biopsy... Read more
Reader Question:
Count Bursae and Not Incisions in Palmar Drainage
Question: In a patient who complained of pain in the hand and inability to move the thumb,... Read more
Reader Question:
Look At Global Period For Repeat Drainage Of Finger Abscess
Question: For a patient who reported back to the ED for a wound check following drainage o... Read more
Reader Question:
Apply One Code for Triplane Tibial Fracture
Question: How do you report the cannulated screw fixation of a triplane fracture?Alaska Su... Read more
Reader Question:
Do Not Confuse Distal Tibial Fracture for Malleolar Fracture
Question: What code would I use for a closed reduction of a distal tibial/fibular fracture... Read more
Reader Question:
Distinguish Ganglion Cyst Excision from Spur Decompression
Question: Our surgeon did the following procedures:1. Right knee arthroscopic excision of ... Read more
Reader Question:
Report Reconstruction for Ray Excision in Toe
Question: Please help with the diagnosis and procedural coding for the procedure mentioned... Read more
You Be the Coder:
Carefully Report 29874 with 29880
Question: We bill for an orthopedic surgeon who frequently codes 29880, G0289, 29874, and ... Read more
Coding Strategies:
Part 2: Overcome These 3 Common Challenges In Hip Replacement Coding
Pay attention to graft retrieval, resurfacing, and femoral block and check on carrier spec... Read more
Coding Tips:
Don't Let Hand Drainage Procedures Drain Your Reimbursement
Coding key: Identify which structures are being drained.When your surgeon performs a drain... Read more
CCI 18.0:
Update Your Multi-layer Compression, Foreign Body Removal Coding With These Edits
If your practice provides neurostimulion services, note these changes.CCI 18.0, effective ... Read more
In Orthopedic Coding Alert, Vol. 15, No. 1, the answer to the reader question "Look At Wha... Read more
Reader Question:
Review Contracts before Directly Billing the Patient
Question: Can you please help us understand if it is better to bill the patient for DME in... Read more
Reader Question:
Code for Conversion from Partial to Total Knee
Question: How do you code for removal of Vanguard prosthesis, to placing the femoral and e... Read more
You Be the Coder:
Look For the Bundle in Chondroplasty and Debridement
Question: How do we report the following procedure in shoulder surgery?"Arthroscopy anteri... Read more
Coding Strategies:
Part 1: Step Up Your Hip Replacement Claims Accuracy With These Tips
Additional procedures that you report determine your reimbursement.A simple hip replacemen... Read more
ICD-10 Update:
Look for Underlying Etiology to Determine Chronic Gout Code in ICD-10
One ICD-9 code expands to five ICD-10 codes.When reporting gout as a cause of arthritis in... Read more
Got a Hip Replacement? Know What Services Are Bundled
You will often need to report a number of different additional procedures with hip replace... Read more
Modifier How-to:
Part 2: Modifier Mythbuster -- Learn the Truth Behind 3 More Common Modifier 24 Myths
Hint: Know your payer's policies on billing complication treatment.To ensure payment for E... Read more
Reader Question:
Look For Definitive Codes for Traumatic Dislocation after Hip Replacement
Question: Our patient, who had undergone a total hip replacement, fell and dislocated his ... Read more
Reader Question:
Look At What Was Dissected In Shoulder Arthroscopy
Question: A 'C arm' fluoroscopy was used to identify an exostosis of the left distal clavi... Read more
Reader Question:
Do Not Report Saucerization with Meniscal Repair
Question: Does the code 29882 (Arthroscopy, knee, surgical; with meniscus repair [medial O... Read more
You Be the Coder:
Turn to Intraoperative Findings in Soft Tissue Ruptures
Question: Our patient, a 76-year-old female, presented for progressively severe pain in th... Read more