2003 Coding changes
The good, the bad and the ugly
By Margie Scalley Vaught, CPC, CCS-P, MCS-P and reviewed by Robert H. Haralson III, MD, and Daniel Sung, JD
With the ringing in of 2003, orthopaedic surgeons received good news in the way of CPT coding changes, but unfortunately there was more disappointing news as well.
The AMA CPT released the following new codes for 2003:
20612 Aspiration and/or injection of ganglion cyst(s), any location
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
29873 Arthroscopy, knee, surgical; with lateral release
29899 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis
62264 Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day
64416 Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration
64446 Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter (including catheter placement), including daily management for anesthetic agent administration
64447 Injection, anesthetic agent; femoral nerve, single
64448 Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration
0027T Endoscopic lysis of epidural adhesions with direct visualization using mechanical means (e.g., spinal endoscopic catheter system) or solution injection (e.g., normal saline), including radiologic localization and epidurography
G0279 Extracorporeal shock wave therapy; involving elbow epicondylitis
G0280 Extracorporeal shock wave therapy; involving other than elbow epicondylitis or plantar fasciitis.
G0289 Arthroscopy, knee, surgical for removal of loose body, foreign body, debridement/shaving of articular cartilage (chrondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee
Trigger point injection codes 20552-20553 were revised removing "muscle groups" and now describe muscle(s) injected. Clarification was provided for reporting these codes, stating report ONCE per session, "regardless of the number of injections, trigger points or muscle(s) injected." Reference to ganglion cyst was removed from codes 20550, 20600 and 20605. Rotator cuff repair codes 23410 and 23412 reference "open" repairs.
With confusion regarding IM rodding of a fracture, CPT added coding guidelines so that IM rodding falls under open treatment codes. In so doing, CPT codes 24516, 27244 and 27759 were revised to say treatment of a fracture.
Any method terminology was replaced with open for codes 25320, 27425, 27730-27734 and 27870.
Diagnostic references were removed from CPT code 27235. It reads, "Percutaneous skeletal fixation of femoral fracture, proximal end, neck."
CPT code 29540 added "foot" strapping to its description. "Two or more" days terminology was added to code 62263.
Guidelines are clarified for codes 62263 and 62264 stating report ONCE for the entire series of injections/infusions. CPT codes 64415 and 64445 are now indicated for single injections.
Physician fee schedule
Disappointing news came in the much-delayed Physician Fee Schedule. Orthopaedic surgeons, on average, took a 10 percent decrease in the majority of services. Total hip and knee arthroplasties took large discounts this year. Code 27130 shows an average of $1263.30 and Code 27447 showing an average of $1359.47, both down approximately $200.
The battle over receiving reimbursement for chondroplasties performed along with meniscectomies on the same knee continues; and the release of CCI edit version 9.0 still lists code 29877 bundled into codes 29881/29880.
AAOS has strongly urged Medicare to reconsider this decision. Medicare decided to add HCPCS code G0289 (see description above) for 2003 while they continue to review the data on chondro- plasty procedures. However, the work RVUs assigned to G0289 is 1.48 based on Medicares feelings that a chondroplasty represents about 15 to 20 minutes of additional work during these sessions. Adding the malpractice RVU of 0.27 brings the total to 2.33, which renders a reimbursement of approximately $86.
Office of the Inspector General
(OIG) 2003 Work Plan
If that was not enough bad news, the OIGs 2003 Work Plan lists the following areas that will be audited in 2003:
Consultation CodesMore than $2 billion paid out in 2000
High level E/M services
Bone density screening
Billing for chiropractic services
Financial arrangements between physicians and Ambulatory Surgical Centers
Incident to servicesnon-physician practitioner services
Payment for therapeutic shoes for diabetic patients
There is some hope from Rep. Bill Thomas (R-Calif.), Chairman of the Committee on Ways and Means, who introduced legislation that would halt the decrease in the Medicare Physician Fee schedule, and would allow physicians to be compensated under the 2002 fee schedule.
With orthopaedic surgeons taking another big hit in reimbursements, it is imperative that offices review and analyze their billing practices and carrier contracts. All avenues of health care services need to be explored to maintain compliance as well as feasibility. AAOS is continuing to work hard to keep members informed and updated.
Margie Scalley 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 firstname.lastname@example.org.
Robert H. Haralson III, MD, MBA, is the medical director of Southeastern Orthopaedics in Knoxville, Tenn. He is the CPT advisor for the Academic Orthopaedic Society and has taught courses on the use of AMA Guides, CPT, the use of computers in medicine and disability medicine. He can be reached at (865) 769-4532 or at email@example.com.
Daniel Sung, JD, is a policy analyst, AAOS department of socioeconomic and state society affairs.
Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.