New, revised, deleted codes set for 2002
Arthroscopy, upper extremity get new codes, many others are revised
By Margie Scalley Vaught
Orthopaedic surgeons and coders need to prepare for changes that will effect their coding and reimbursement for 2002. Following is a list of new, revised and deleted codes—all for 2002.
One area in orthopaedic coding that added many codes is in the Arthroscopy section. The following codes were added to this section giving arthroscopic Mumford, Capsulorrhapies and SLAP lesion repairs, their own recognition:
29805 Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)
29806 Arthroscopy, shoulder, surgical; capsulorrhaphy
29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion
29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)
New codes in the arthroscopy section also were added for metacarpal joint scopes:
29900 Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsy
29901 Arthroscopy, metacarpophalangeal joint, surgical; with debridement
29902 Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament (e.g., Stenar lesion)
In addition to these changes, the unlisted Arthroscopy code also was changed.
29999 Unlisted Procedure, arthroscopy
Many orthopaedic offices have struggled in the area of trigger point injections and how many could be billed in a region or area. Several new codes were added for 2002.
20526 Injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel
20551 Injection; tendon origin/insertion
20552 Injection; single or multiple trigger point(s), one or two muscle group(s)
20553 Injection; single or multiple trigger point(s), three or more muscle group(s)
We will have to see how CPT addresses what is considered a "muscle group."
In the upper extremity section several new codes were also added to reflect the services that are being performed, but have lacked appropriate CPT codes. The new codes for these upper extremity procedures are:
24300 Manipulation, elbow, under anesthesia
24332 Tenolysis, triceps
24343 Repair lateral collateral ligament, elbow, with local tissue
24344 Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)
24345 Repair medial collateral ligament, elbow, with local tissue
24346 Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)
25001 Incision, flexor tendon sheath, wrist (e.g., flexor carpi radialis)
25024 Decompression fasciotomy, forearm and/or wrist, flexor and extensor compartment; without debridement of nonviable muscle and/or nerve
25025 Decompression fasciotomy; forearm and/or wrist, flexor and extensor compartment; with debridement of nonviable muscle and/or nerve
25259 Manipulation, wrist, under anesthesia
25275 Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (e.g., for extensor carpi ulnaris subluxation)
25394 Osteoplasty, carpal bone, shortening
25430 Insertion of vascular pedicle into carpal bone (e.g., harii procedure)
25431 Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular) (Includes obtaining graft and necessary fixation), each bone
25651 Percutaneous skeletal fixation of ulnar styloid fracture
25652 Open treatment of ulnar styloid fracture
25671 Percutaneous skeletal fixation of distal radioulnar dislocation
26340 Manipulation, finger joint, under anesthesia, each joint
29086 Application, cast; finger (e.g., contracture)
Because of the new codes being added to CPT for 2002, many of the existing codes needed revisions or deletion. The deleted codes for 2002 are:
26585, 26597, 29815, 29909
Some of the revision or changes in the existing codes were made to allow proper assignment and recognition of the new codes. For this reason many codes had what CPT calls "terminology" revisions, reflecting the adoption of the new codes, and other code changes were just in grammatical content. The codes that are reflected as being "revised" for 2002 are:
20225 Biopsy, Bone, Trocar, or needle; Deep (e.g. vertebral body)
20550 Injection; tendon sheath, ligament, ganglion cyst
23000 Removal of subdeltoid calcareous deposits, open
23350 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography
24075 Excision, tumor, soft tissue of upper arm or elbow area; subcutaneous
24076 Excision, tumor, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)
25020 Decompression fasciotomy, forearm and/or wrist, flexor or extensor compartment; without debridement of nonviable muscle and/or nerve
25075 Excision, tumor, soft tissue or forearm and/or wrist area; subcutaneous
25076 Excision, tumor, soft tissue or forearm and/or wrist area; deep (subfascial or intramuscular)
25274 Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscle
25405 Repair of nonunion or malunion, radius or ulna; with autograft (includes obtaining graft)
25420 Repair of nonunion or malunion, radius and ulna; with autograft (includes obtaining graft)
25440 Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)
25443 Arthroplasty with prosthetic replacement; scaphoid carpal (navicular)
25520 Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation)
25526 Open treatment of radial shaft fracture, with internal and/or external fixation and open treatment, with or without internal or external fixation of distal radioulnar joint (Galeazzi fracture/dislocation)
25645 Open treatment of carpal bone fracture (other than carpal scaphoid (navicular)), each bone
26115 Excision, tumor or vascular malformation, soft tissue of hand or finger; subcutaneous
26116 Excision, tumor or vascular malformation, soft tissue of hand or finger; deep (subfascial or intramuscular)
26160 Excision of lesion of tendon sheath or joint capsule (e.g., cyst, muscus cyst, or ganglion), hand or finger
26350 Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (e.g., no man’s land); secondary with free graft (includes obtaining graft), each tendon
26356 Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (e.g., no man’s land); primary or secondary without free graft, each tendon
26390 Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod
26392 Removal of synthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each rod
26415 Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod
26416 Removal of synthetic rod and insertion of extensor tendon graft (including obtaining graft), hand or finger, each rod
26426 Repair of extensor tendon, central slip, secondary (e.g., boutonniere deformity); using local tissue(s), including lateral band(s), each finger
26428 Repair of extensor tendon, central slip, secondary (e.g., boutonniere deformity); with free graft (includes obtaining graft), each finger
26445 Tenolysis, extensor tendon, hand or finger; each tendon
26510 Cross intrinsic transfer, each tendon
26587 Reconstruction of polydactylous digit, soft tissue and bone
26590 Repair macrodactylia, each digit
26607 Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone
26670 Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia
26676 Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb; with manipulation, each joint
26685 Open treatment of carpometacarpal dislocation, other than thumb; with or without internal or external fixation, each joint
26843 Arthrodesis, carpometacarpal joint, digit, other than thumb, each
27110 Transfer iliopsoas, to greater trochanter of femur
27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (Total hip arthroplasty), with or without autograft or allograft
27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft
27140 Ostetomy and transfer of greater trochanter of femur (separate procedure)
27185 Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter of femur
27447 Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty)
27475 Arrest, epiphyseal, and method (e.g., epiphysiodesis); distal femur
28104 Excision of curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneous;
28238 Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (e.g., Kidner type procedure)
28299 Correction, hallux valgus (bunion), with or without sesamoidectomy; by double osteotomy
28737 Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (e.g., Miller type procedure)
29049 Application, cast; figure-of-eight
29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
Margie Scalley Vaught, CPC, is an independent coding specialist in Ellensburg, Wash. She also is a member of the American Academy of Professional Coders National Advisory Board.
Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.