October 2003 Bulletin

Common coding questions and answers

Carefully review procedures, codes

By Margie Scalley Vaught, CPC, CCS-P, MCS-P and reviewed by Robert H. Haralson III, MD

In this issue of the Bulletin, our coding experts decided to respond to some common coding questions submitted by AAOS Fellows. Although we are unable to answer questions on an individual basis, these responses may prove helpful to your practice.

Question:

If a resident in our group takes call for Dr. A at the emergency department and performs a closed reduction with manipulation of a displaced Colles’ fracture—per Dr. A’s phone request and is instructed to have the patient come back to our clinic in five days, how should this visit be coded when the patient comes back to the clinic?

Answer:

To bill for the resident performing the closed reduction with manipulation of the Colles’ fracture, there needs to be supervision from Dr. A in your orthopaedic group—and this applies to other orthopaedists directing residents—as outlined in the Medicare Carriers Manual, Section 15016.

If supervision is not taking place, it will be hard to support your group’s billing for the closed reduction with manipulation. When the patient comes to your office, the patient is coming for follow-up reduction fracture care service. Your group should then report the appropriate CPT code such as 25605 and append modifier –55 to indicate postoperative care.

It would NOT be appropriate to report this follow-up service under the closed treatment without a manipulation code because a manipulation was performed, and now the patient is coming in for follow-up per Dr A’s recommendations.

Question:

A patient had a unicompartmental knee arthroplasty using code 27446. One year later, the patient had a revision of the hemiarthroplasty to a full arthroplasty. What codes would best represent this removal of the old compartment and then placement of a new total knee arthroplasty component?

Answer:

Normally, this would be coded 27487. The revision code includes the removal of the old prosthesis. However, depending upon documentation and the situation, this could also be coded 27447 and 27488 -51.

Note: This is not a revision of a total knee replacement. Except for removal of a partial tibial tray and femoral metal runner, the procedure is the same work as a primary total knee.

Question:

How would you code for an Elmslie-Trillat procedure on the knee. Should code 27418 or 27422 to be used? .

Answer:

Technically, it will depend on the documentation because there are several CPT codes that could describe the procedure being performed. Also, many physicians can use varying techniques.

Question:

If a below the knee amputation was performed and due to chronic infection and further disease process you now had to perform an above the knee amputation, would CPT code 27596 be appropriate? (Since the majority of the leg has already been removed, it would not seem correct to bill out 27590. Also, since you are going from a below the knee to an above the knee, it would not seem to be appropriate to report 27886 as a reamputation.)

Answer:

In CPT, the reamputation code is indented under either the femur or leg, tibia and fibula. Therefore, it only applies to that body part. You would use 27590 if you did an above knee amputation—after a previous below the knee amputation. Also, a -78 modifier would be applied if it occurred during the global period. The amount of work is the same whether you are amputating a partially missing leg below the knee or above the knee.

Question:

How do you report the following: an arthroscopic anterior shift, with anterior labral repair and a posterior capsular plication/shift and a superior rotator interval closure are all performed on the same shoulder. Are all of these procedures to be billed 29806 only or with -22 or with a 29807 with it? Note: there is no mention of a SLAP lesion II or IV involved.

Answer:

If there was just a SLAP repair for a SLAP lesion—but not a capsular defect—it could be coded using 29807. To report both 29807 and 29806, there must be a capsular defect and a SLAP lesion. Currently, rotator cuff interval closure is considered inherent in the major procedure because technically there is no rotator cuff—but extra measures are taken to provide a good stabilization of the shoulder. The AAOS CPT/ICD Coding Committee is currently looking into the issue of rotator cuff interval closures.

Question:

There is confusion as to when to report 23420 versus 23412 and the actual number of muscles torn. Is it true that there must be three major muscles torn and/or avulsed before using the 23420 code?

Answer:

The CPT description of code 23420 cites: “Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty).” You can have a cuff avulsion—where the supraspinatus and the infraspinatus muscles are torn so severely that reconstruction is necessary to bring the cuff back up into anatomic location. Since shoulder injuries and RCT can vary from patient to patient, the orthopaedist needs to document the extent of the injury and if it is a repair versus a reconstruction. (A reconstruction is more then just anchors and tacks.)

Question:

Are there time frames associated with the spine re-exploration codes?

Answer:

The reexploration codes were intended for surgery done significantly later than the original operation. These series of codes should be used when beyond the global period of 90 days. Within the global, the same code with -76 would be appropriate since typically the circumstances are recurrent disk displacement rather than residual.

Question:

Can you report 63047 & 22630 together?

Answer:

When it comes to coding 22630 and 63047 there must be justification such as a far lateral disc problem.

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


Robert H. Haralson III, MD, MBA, is the medical director of Southeastern Orthopaedics in Knoxville, Tenn. He is the chair of the AAOS CPT and ICD Coding Committee and 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.


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