February 2001 Bulletin

New codes added, revised in 2001 CPT

Physician Fee Schedule has changes in use of ultrasound, casting supplies

By Margie Scalley Vaught,

The AMA added several new codes to the 2001 CPT manual affecting orthopaedic surgeons in regards to spine procedures. Vertebroplasty was added as a new Subsection with the following codes added:

Two new codes were added for radiological guidance when used with vertebroplasty.

Laminotomy codes 63040 and 63042 were revised to reflect "single interspace" when reexploration were done. With that revision two codes were needed for additional interspaces.

In the Spine Section of CPT, new guidelines were added reflecting the use of co-surgeons during spinal procedures. A new example was provided representing "Surgeon A performing an anterior exposure of the spine with mobilization of the great vessels. Surgeon B performing anterior (minimal) diskectomy and fusion" and how modifier —62 is utilized.

Revised terminology affected two codes in the Musculoskeletal System, codes 23615 and 27236. With the AMA striving for consistency, revised terminology played a key role in the Radiology Section. Instead of actual types of radiological views in the definitions, number of views will be stated. Such as code 72040, "Radiological examination, spine, cervical; two or three views." The importance of providers documenting the actual number of views ordered and/or taken is now apparent. New MRI codes were also added to reflect those test performed on locations other than joints, such as code 73218 "MRI, upper extremity, other than joint, without contrast material(s)."

Other areas of change taking place in 2001 can be located in the Physician Fee Schedule (See Federal Register Nov. 1, 2000). Low-intensity ultrasound as a treatment for nonunion of extremity fractures will be covered after April 1, 2001 with code 20979. Casting supplies also were addressed in the Fee Schedule. Effective Jan 1, 2001, all supplies used in the application of casts can be billed. This change applies for fractures and/or dislocations only. The padding, stockette, foam, etc., in addition to the fiberglass or plaster can be billed. If applying a cast for sprains or other conservative treatment not related to a fracture and/or dislocation, this extra supply billing cannot be used. Currently there are no HCPCS codes specified to represent the added supplies, so unlisted HCPCS codes will need to be used.

CCI (Correct Coding Initiative) Version 6.3 took many offices by surprise. It was released with effective date of Oct. 31, 2000, but it was not until denied claims started to arrive that offices realized a drastic change had taken place in regards to bundling. Under this version, E/M services were bundled into many radiological procedures performed on the same day, if the same provider and/or tax identification number provided the services. Routine radiology codes used in an orthopaedist’s office do not require a -25 modifier. The codes that do are mainly for arthrograms, MRIs, and CT scans, and these are rarely performed in an office setting. In order to receive reimbursement, modifier -25 would need to be applied to the E/M if indicated. Modifier -25 has distinct and strict usage guidelines that need to be followed for appropriate application.

This is just the beginning of changes that are taking place. Look for more adjustments with the final rulings of portions of the Health Insurance Portability and Accountability Act (HIPAA) and Stark II to impact orthopaedic surgeons in the near future.

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.

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