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Orthopedic Coding Alert

Never Miscode Bankart Procedures Again - Thanks to CPT 2004

The new coding manual teaches coders how to boost reimbursement for this common arthroscopic procedure The new edition of CPT finally lays an old dog to rest and instructs coders on the proper way to report arthroscopic Bankart procedures, resulting in fewer claim denials and additional reimbursement for those coders who heed CPT's advice.
 
CPT 2004 directs surgeons who perform Bankart procedures through the scope to report 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy).
 
Although the AMA once advised coders to use 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion) for this procedure, a new parenthetical note following the open Bankart code (23455, Capsulorrhaphy, anterior; with labral repair [e.g., Bankart procedure]) directs coders to use 29806 for the arthroscopic version of this shoulder repair.
 
Because the RVUs for 29806 are higher than for 29807 (27.54 vs. 26.77), this new advice will allow orthopedic surgeons to collect more reimbursement for Bankart procedures than in the past.
  
"With this change to the parenthetical note, the AMA has finally put to rest one of the most talked-about coding dilemmas for orthopedic coders," says Heidi Stout, CPC, CCS-P, coding and reimbursement manager at University Orthopaedic Associates in New Brunswick, N.J. "Directing coders to report 29807 for arthroscopic Bankart repair never sat right with me, as the descriptor associated with that code limits its use to repair of a superior labrum anterior posterior (SLAP) lesion. SLAP repair and Bankart repair are not one and the same." CPT Adds New Spinal Surgery Section CPT 2004 offers a new and much-needed subsection to the spinal surgery codes. The codes for lateral extracavitary approach technique will allow spine coders to forego the unlisted-procedure code and start getting specific.
 
CPT introduced two base codes and one add-on code:

22532 - Arthrodesis, lateral extracavitary technique, including minimal diskectomy to prepare interspace (other than for decompression); thoracic
 
22533 - ... lumbar
 
+22534 - ... thoracic or lumbar, each additional vertebral segment (list separately in addition to code for primary procedure).
 
According to the AMA's CPT Changes 2004 - An Insider's View, CPT added these codes to describe "vertebral body resection and fusion procedures at a single thoracic and lumbar level of the spine."
 
Although CPT previously contained arthrodesis codes for anterior, anterolateral, posterior, posterolateral and lateral transverse techniques, coders were stuck using the unlisted-procedure code (22899) for the lateral extracavitary technique that allows a lateral view of the vertebral body.
 
Assuming that insurers will carry over CPT's prior arthrodesis coding guidelines to the three new codes, you can report 22532 and 22533 along with other procedures when necessary, as long as you append modifier -51 (Multiple procedures) to the arthrodesis code. Code 22534, on the other hand, is an add-on code, so you cannot append modifier -51 and [...]


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