February 2002 Bulletin

AMA CPT symposium addresses six issues

2002 changes explained

By Margie S. Vaught, CPC, CCS-P, MCS-P

The American Medical Association’s (AMA) Annual CPT Coding Symposium was held in Chicago on November 16, 2001 to explain coding revisions for 2002. Five code changes that impact orthopaedic surgeons and one procedure that remained without its own code were among the topics addressed. They are summarized here.

Addition to Modifier 62

The following description was added to Modifier 62: "When two surgeons work together as primary surgeons performing distinct part(s) of a procedure, each surgeon should report his/her distinct operative work by adding the modifier —62 to the procedure code and any associated add-on code(s) for that procedure as long as both surgeons continue to work together as primary surgeons. …"

This change affects several subsection guidelines in the CPT. The Spine (Vertebral Column) section reminds us that this modifier should not be appended for bone graft codes 20900-20938, and "The modifier —62 may not be appended to the definitive or add-on spinal instrumentation procedure code(s) 22840-22855." The Spine Section under Excision guidelines states: "For the following codes, when two surgeons work together as primary surgeons performing distinct part(s) of partial vertebral body excision, each surgeon should report his/her distinct operative work by appending modifier —62 to the procedure code."

In this situation the modifier —62 may be appended to the procedure(s) 22100-22102, 22110-22114, and, as appropriate to the associated additional vertebral segment add-on code(s) 22103, 22116 as long as both surgeons continue to work together as primary surgeons."

This wording appears under the Spine and Vertebral Body procedures as well as the Anterior approaches for decompression procedures. For orthopaedic surgeons using a general surgeon or other co-surgeon for spinal cases, the guidelines will need to be revisited.

Trigger and tendon point injections received an over haul for 2002

Three new codes were added for injections

The CPT Panel did not give further instructions regarding the definition of ‘muscle groups’ and when the question was posed at the AMA Symposium they stated, "we specifically left the definition of muscle groups vague." The feeling was that depending on the specialty, rheumatology or orthopaedics, each would be defining their ‘muscle groups.’

It appears, however, that no matter how many different locations and/or muscle groups you inject on a given day, code 20553 could to be the maximum coding allowed. So if a patient has bilateral trigger points injected in both shoulders and elbows, code 20553 describing three or more would apply.

The RVUs assigned these three new injection codes (20551-20553) all reflect the same value. So even though code 20553 is for three or more it has the same value as code 20552, per the Federal Register. Offices will want to check with their carriers to find out about bilateral modifier usage as the Federal Register has indicated that these trigger point injection codes do not fall under the bilateral modifier payment schedule.

New arthroscopy codes were added for the upper extremities

No CPT code for arthroscopic-assisted rotator cuff repair

That procedure is still reported using the unlisted code 29999. Throughout the shoulder and shoulder arthroscopy sections, cross-references are made to the correct CPT code depending on approach. There is also the notation that "thermal capsulorrhaphy should be reported as 29999."

New manipulation codes added

Manipulation, elbow under anesthesia (24300), Manipulation, wrist, under anesthesia (25259) and Manipulation, finger joint, under anesthesia, each joint (26340). Clear guidelines were not given to the interpretation of ‘under anesthesia.’

However, Daniel Nagle, MD, the liaison to the AMA CPT Editorial Panel for the American Society for Surgery on the Hand (ASSH) and a speaker at the AMA symposium, stated that it should " . . . represent ‘appropriate anesthesia’ for the procedure and not default to general or regional anesthesia only."

Orthopaedic offices will want to obtain clarification from carriers while waiting to see how CPT will define the ‘under anesthesia’ and if it will include local hematoma blocks, digital blocks, etc.

Reimbursement for waterproof cast padding

A number of orthopaedic surgeons have sent questions recently regarding billing and reimbursement for waterproof cast padding such as Procel, under the new Q codes. This issue actually was addressed last year in the November 1, 2000 edition of the Federal Register. In that publication it was stated that, "The purpose of the proposal was not to list all the casting supplies that could be separately billable, but rather to delete from our CPEP (Clinical Practice Expert Panel) input database any casting supplies that are currently listed. Because the Procel cast liner is not currently in our database, it does not need to be deleted."

Procel was never included in the ‘global package’ related to cast supplies or fracture care and thus offices should bill and be reimbursed for these supplies, in addition to the normal fiberglass supplies. CMS stated Q4050 would appear appropriate for the coding of Procel cast liners. As further updates are made regarding Q codes, the AAOS Bulletin will keep you informed.

Margie S. Vaught, CPC, CCS-P, MCS-P, is an independent coding specialist in Ellensburg, Wash. She is also a member of the American Academy of Professional Coders’ National Advisory Board. She can be reached at vaught@kvalley.com

Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.

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