Are you ready for 2006?
Here are new codes orthopaedic offices should know
By Margie Scalley Vaught, CPC, CCS-P, CPC-H, ACS-OR, and M. Bradford Henley, MD
Each year brings new codes, new rules and changes to current codes. For 2006, orthopaedic offices should be aware of the following new codes and changes.
Musculoskeletal CPT codes
In 2006, there are six new musculoskeletal CPT (common procedure terminology) codes:
• 22010–Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic or cervicothoracic
• 22015–Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral or lumbarsacral
• 22523–Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); thoracic
• 22524–Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); lumbar
• 22525–Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device, one vertebral body, unilateral or bilateral cannulation (eg, kyphoplasty); each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure)
• 28890–Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia
Physicians using the kyphoplasty codes may also report radiological imaging.
Additional new codes
There are also 37 new grafting codes within the code range 15000-15431, as well as four changes to existing codes and six deleted codes. Orthopaedic surgeons will need to become familiar with these changes and should be careful when reporting grafting codes.
Some of the new grafting codes include: Allograft temporary coverage (15300-15301; 15320-15321); Acellular dermal allograft (15330-15336); Tissue-cultured allogeneic skin/dermal substitute (15340-15341; 15360-15366); and Xenograft temporary and implant (15420-15421 and 15430-15431).
Confirmatory consultation codes (99271-99275) and follow-up inpatient codes (99261-99265) have been deleted. Additionally, the guidelines for reporting consultation codes have been changed. Under the new guidelines for 2006, if a patient requested a second surgical opinion, you would report the appropriate evaluation and management (E/M) level code and not a consultation code. If, however, the carrier requested the second surgical opinion, you would use the appropriate outpatient or inpatient consultation codes with modifier –32 appended.
New codes and guidelines for intramuscular (IM) injections as well as intravenous (IV) infusion codes are among the changes for 2006. The appropriate administrative code for a patient who receives an IM injection of Toradal would be 90772, along with the J code for Toradal. These changes directly correlate to the use of G codes implemented in 2005 by the Centers for Medicare and Medicaid Services (CMS).
Training codes for orthotics and prosthetics have been added and renumbered so they appear in the appropriate coding section. Training codes now include: 97760 “Orthotic management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk each 15 minutes;” 97761 “Prosthetic training, upper and/or lower extremity(s), each 15 minutes” and 97762, which replaces code 97703 and represents “Checkout for orthotic/prosthetic use, established patient, each 15 minutes.”
Codes 99141 and 99142 (conscious sedation) have been deleted and replaced by codes based on Moderate Sedation and who is supplying the sedation—the surgeon or a person not performing the procedure—and the age of the patient. However, CMS has not assigned Relative Value Units to these codes, and bundles them within other procedures. Check with your carriers to see if they will reimburse you for these new codes.
New codes have also been added to the Healthcare Common Procedure Coding System (HCPCS), including several new codes for various orthoses and braces. The new codes include:
• A9535–Injection, methylene blue, 1 ml
• E1812–Dynamic knee, extension/flexion device with active resistance control
• L0491-L0492–Thoracic-lumbar-sacral orthosis (TLSO) brace
• L0621-L0624–Sacroiliac orthosis
• L0625-L0640–Lumbar orthosis
Physician Fee Schedule
Reporting of casting supplies still falls under the Q codes (Q4001-Q4051) for 2006. CMS has decided not to delete these codes yet, but will continue to evaluate them during 2006. Offices and facilities should remember to bill for their casting and splinting supplies; failure to report these codes is lost revenue.
The multiple reduction of the technical component for magnetic resonance images (MRIs) and computed tomography scans (CTs) will be 25 percent in 2006 and 50 percent in 2007. The professional component will not be reduced. Here’s how this reduction would work: A patient is scheduled to have an MRI of the both the cervical and lumbar spine on the same date of service and same appointment time. In 2006, one of the MRI’s technical components will be reduced by 25 percent.
In October 2005 CMS also announced that payment for code G0289 will be reduced by 50 percent when it is reported with other codes and that bone grafting codes 20931, 20937 and 20938 also will be reduced by 50 percent under the multiple reduction status indicator 2. (According to CMS guidelines, “status indicator 2” is defined in this way: “Standard payment adjustment rules for multiple procedures apply. If a procedure is reported on the same day as another procedure with a 1, 2, or 3, rank the procedures by fee schedule and apply the appropriate reduction to this code [100 percent, 50 percent, 50 percent, 50 percent, 50 percent and by report]. Base payment on the lower of actual charges or fee schedule amount reduced by the appropriate percentage.”)
Physicians must document and accurately report the services rendered to ensure they receive full reimbursement and appropriate claims processing. CMS will be issuing updates throughout the year so you can keep track of further changes. CMS will also be releasing its Improper Payment Audits and Office of the Inspector General’s (OIG) Work Plan for 2006. To review these documents, visit:
• HHS OIG Work Plan for 2006: http://oig.hhs.gov/publications/workplan.html#1
• HHS OIG Fraud Alerts, Bulletins and Other Guidance: http://oig.hhs.gov/fraud/fraudalerts.html
• HHS OIG Fraud Enforcement Actions: http://oig.hhs.gov/fraud/enforcementactions.html
• HHS OIG Fraud Advisory Opinions: http://oig.hhs.gov/fraud/advisoryopinions.html
• Physician Fee Schedule for 2006: http://www.cms.hhs.gov/physicians/pfs/default.asp
• Pub 100-04 Transmittal 672 - October Update to the 2005 Medicare Physician Fee Schedule Database: http://new.cms.hhs.gov/MedlearnMattersArticles/downloads/MM4031.pdf
M. Bradford Henley, MD, is chairman of the AAOS Coding, Coverage and Reimbursement Committee
Margie Scalley Vaught, CPC, CCS-P, CPC-H, ACS-OR, is an independent coding specialist and BONES member who has served on the National Advisory Board for the American Academy of Professional Coders. She can be reached at firstname.lastname@example.org