Includes procedures in pediatric orthopaedics, hip and knee arthroscopy. HCFA delays new documentation guidelines for E/M services until June 30, 1998.
by Laura Nuechterlein
Ten new codes have been added to the Musculoskeletal System section of the AMA Physicians’ Current Procedural Terminology 1998. These new codes, listed below, include procedures in the areas of pediatric orthopaedics, hip arthroscopy and ankle arthroscopy.
20664: Application of halo, including removal, cranial, six or more pins placed, for thin skull osteology (e.g., pediatric patients, hydrocephalus, osteogensis imperfecta), requiring general anesthesia
22818: Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or two segments
22819: three or more segments
29860: Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)
29861: Arthroscopy, hip, surgical; with removal of loose body or foreign body
29862: with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum
29863: with synovectomy
29891: Arthroscopy, ankle, surgical; excision of osteochondral defect of talus and/or tibia, including drilling of the defect
29892: Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)
29893: Endoscopic plantar fasciotomy
In addition to these changes, there are additions and revisions to several codes in the Integumentary System section. The full list of new, revised, and deleted codes can be found in the CPT 1998 manual. In addition, an Instructional Course on CPT Coding will be presented at the Academy’s Annual Meeting. This course will include a section discussing the new orthopaedic CPT codes.
Another important coding issue for 1998 is the new documentation guidelines for evaluation and management (E/M) services. These guidelines, which were published jointly by the AMA and the Health Care Financing Administration (HCFA), are not included in CPT 1998, but can be obtained from the HCFA website or by contacting the Academy at (800) 346-2267. The guidelines include instructions on appropriate documentation for the three key components for every level of E/M service: history, physical examination and medical decision-making.
HCFA had planned to begin enforcement of these guidelines with random prepayment audits on January 1, 1998. However, due to the complexity of the new requirements and the need to educate physicians on their use, HCFA has granted a six-month "grace period" until June 30, 1998. Random prepayment audits of claims for E/M services will continue, but physicians will not be required to adhere to the 1997 guidelines until July 1, 1998. During this period, the Academy will continue its ongoing efforts to educate orthopaedic surgeons on the new documentation guidelines.
Orthopaedic surgery continues to have a significant voice in procedural and E/M coding through its representation on the AMA CPT Editorial Panel and AMA CPT Advisory Committee. Robert H. Haralson, MD, is the orthopaedic representative to the CPT Editorial Panel, which has final authority over the addition, deletion or revision of CPT codes. Orthopaedic representatives to the CPT Advisory Committee include Blair C. Filler, MD, American Orthopaedic Association; Richard L. Wixson, MD, Academy; Walter J. Pedowitz, MD, American Orthopaedic Foot and Ankle Society; Thomas S. Whitecloud, MD, North American Spine Society; and Daniel J. Nagle, MD, American Society for Surgery of the Hand.
If fellows have suggestions for additions or revisions of orthopaedic procedure codes, they may contact their society’s CPT Advisor, or forward the suggestions to the Academy’s CPT and ICD Coding Committee. Fellows with specific coding questions also may send those questions, along with an operative report, to the CPT and ICD Coding Committee at the Academy, 6300 N. River Rd., Rosemont, Ill. 60018.
Answers to common coding questions may be addressed in future editions of the Bulletin. Fax (847) 823-8026.
Laura Nuechterlein is a policy analyst in the Academy’s department of health policy and practice.