Mary LeGrand, RN, MA, CCS-P, CPC
The 2013 CPT Manual includes few new orthopaedic surgical CPT code changes, but many guideline changes. One clarification throughout the manual, especially in the E&M and Modifier sections, relates to the term “physician.” Not only medical doctors can use these codes and report these services; “other qualified healthcare professionals” such as physician assistants and nurse practitioners use the same codes.
This article addresses key orthopaedic-related changes. Always refer to the entire CPT Manual for the full list of revisions, deletions, and additions.
The AAOS has a complete series of coding support materials that address 2013 code updates.
Orthopaedic-specific surgical CPT code changes
Guidelines have been revised in the following areas:
Spine CPT Errata—Changes formalized for 2013. A guideline change has been added to the spine bone grafts (20930–20938), instrumentation (22840–22844, 22848, 22845–22847), and intervertebral device (22851) CPT codes. The change supports a CPT Errata issued in May 2012 that addressed the omission of CPT codes 22633 and 22634 as appropriate primary or index codes for bone graft, instrumentation, and intervertebral device codes. These codes may be appropriately related.
Bone marrow aspirate—Clarification has been added following the bone graft codes (20930–20938) related to bone marrow aspiration. CPT code 38220 defines the work associated with the harvest of bone marrow for bone grafting; it should not be used to report bone marrow aspirate for platelet-rich stem cells. Instead, Category III code 0232T should be used when bone marrow aspiration is performed for platelet-rich stem cell.
Cervical Spinal Arthrodesis Guideline—Guidelines were added to CPT codes 22554, 22585, 63075, and 63076; if the work associated with these procedures is performed during the same surgery by the same surgeon or by two separate surgeons/individuals during the same session, the correct codes are 22551 and 22552. CPT codes 63075 and 22554 may not be unbundled and reported for the same patient, same session.
Cast application—Guideline changes were made in the “Application and Strapping” section addressing the application of the first cast, its removal, coding by the individual who performs the initial service, and restorative management. Refer to the section for specific comments. CPT code 29590 (Denis-Browne bar [splint] with manipulation and casting [eg, for metatarsus adductus, clubfoot]) was deleted.
Hip arthroscopy—Under a new guideline instruction, CPT code 29916 (Arthroscopic labral repair of a torn labrum) is considered inherent to CPT codes 29915, 29862, and 29863. CPT code 29916 should not be reported in addition to CPT codes 29915, 29862, or 29863 because the repair is already included in these codes, whether as a takedown and repair or a repair of an already torn labrum. This guideline is not new information, but a clarification based on inquiries received since the introduction of the new hip arthroscopy codes.
Chemodenervation—A guideline change was introduced for CPT code 64614 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) [eg, for dystonia, cerebral palsy, multiple sclerosis]). CPT code 64614 may only be reported once per extremity. The parenthetical (s) was removed from extremity. A parenthetical instruction following CPT code 64614 states that modifier 50 should not be appended to this code. Check with your payers to determine specific rules to code submission.
Intraoperative nerve monitoring—Clarification was added in the Intraoperative Neurophysiology section. Intraoperative nerve monitoring by the operating surgeon is included in the primary surgical service and is not separately reportable. This is a clarification—not a new instruction.
New CPT codes
The following are new CPT codes for 2013:
22586—Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace (2013 Interim Work RVUs: 28.12)
0309T—Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4-L5 interspace (List separately in addition to code for the primary procedure) Note: Category III code 0309T is an add-on code to 22586.
Both CPT codes 22856 and 0309T include the work associated with the following CPT codes: 20930–20938, 22840, 22848, 72275, 77002, 77003, 77011, 77012. When reporting CPT codes 22586 or 0309T, do not report any of these codes. Both CPT codes 22856 and 0309T reflect work performed at the L5-S1 and the L4-L5 interspaces.
23473—Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component (2013 Interim Work RVUs: 25.00)
23474—Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component (2013 Interim Work RVUs: 27.21)
These new codes were created to address the 5-Year Work Review and reporting of the combination procedures for revision total shoulder arthroplasty.CPT codes 23473 and 23474 describe the revision of a total shoulder arthroplasty, including the removal of the humeral and/or glenoid component and replacement with a new prosthesis in the same shoulder.
Guideline changes instruct the physician that CPT codes 23331 and 23332 should not be reported with 23473 and 23474. Remember, a revision describes the work associated with both the removal and the replacement of the artificial prosthesis during the same operative session.
24370—Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component (2013 Interim Work RVUs: 23.55)
24371—Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component(2013 Interim Work RVUs: 27.50)
Similar revisions are introduced for elbow arthroplasty based on the same logic as the revision shoulder arthroplasty codes. Guideline instructions state that CPT code 24160 (Implant removal; elbow joint) should not be reported with the new revision codes. An additional guideline found with CPT code 24363 (Arthroplasty, elbow: with distal humerus and proximal ulnar prosthetic replacement [eg, total elbow]) refers the reader to the new codes (24370 and 24371).
Guideline instructions related to the reporting of electromyograms (EMGs) and nerve conduction studies (NCS) are found in the beginning of their respective CPT sections. CPT codes 95900–95904 were deleted and replaced by the following CPT codes:
95907—Nerve conduction studies; 1–2 studies
95908—Nerve conduction studies; 3–4 studies
95909—Nerve conduction studies; 5–6 studies
95910—Nerve conduction studies; 7–8 studies
95911—Nerve conduction studies; 9–10 studies
95912—Nerve conduction studies; 11–12 studies
95913—Nerve conduction studies; 13 or more studies
Guideline instruction explains how to report the codes for the purposes of billing. A single conduction study is defined as a sensory conduction test, a motor conduction test with or without an F wave test, or an H-reflex test. Each type of study (sensory, motor with or without F wave, H-reflex) for each nerve includes all orthodromic and antidromic impulses associated with that nerve and constitutes a distinct study when determining the number of studies in each grouping (eg, 1–2 or 3–4 nerve conduction studies). Each type of nerve conduction study is counted only once when multiple sites on the same nerve are stimulated or recorded.
Extracorporeal Shock Wave: Wound Healing
Two new Category III codes for extracorporeal shock wave for wound healing were introduced:
0299T—Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound
0300T—Each additional wound (List separately in addition to code for primary procedure.)
As a result of the new codes, a guideline change is introduced for CPT code 28890 (Extracorporeal shock wave, high energy, performed by a physician or other qualified healthcare professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia). The guideline states that CPT code 28890 may not be reported with the new codes 0299T and 0300T; a similar guideline with the new codes indicates they may not be reported with CPT code 28890.
- Review the 2013 CPT Manual in its entirety to understand the guideline changes found throughout it. Specifically focus on the E&M changes and new codes that may have applicability to your practice.
- Update charge capture tools, electronic health record (EHR) lists and short lists or favorites, if charge capture is performed within the EHR.
- Attend an AAOS-sponsored coding course.
Mary LeGrand, RN, MA, CCS-P, CPC, is a consultant with KarenZupko & Associates, Inc. This article has been reviewed by the AAOS Coding, Coverage, and Reimbursement Committee.
December 2012 Issue
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