Current Procedure Terminology (CPT®) 2009 contains several new and revised CPT codes and Guideline instructional changes. Last month’s column reviewed changes to fractures and “G” codes, general musculoskeletal CPT codes, anesthetic agents, and cervical disk arthroplasty code additions and revisions. This month we review more new CPT and HCPCS codes applicable to orthopaedics as well as changes to the evaluation and management (E & M) codes; be sure to review the entire CPT 2009 for changes that may affect your individual practice.

Decompression fasciotomies
Two new codes were added in 2009 to reflect the work associated with fasciotomies of the pelvic (buttock) compartments. Code 27027 is found in the Incisional section and does not include débridement of the nonviable muscle. Code 27057 is found in the Excisional section and includes débridement of nonviable muscle. Both codes may be reported as bilateral procedures by appending the modifier -50 when appropriate.

• 27027—Decompression fasciotomy(ies), pelvic (buttock) compartment(s), (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), unilateral
• 27057—Decompression fasciotomy(ies), pelvic (buttock) compartment(s), (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with débridement of nonviable muscle, unilateral

CPT codes 11040-11043 are not separately reportable and are considered inclusive to CPT codes 27027 and 27057.

Spine and spinal cord
One new code was added, and several others revised, as follows:

• 62263—Refer to the Guideline Changes specific to injection of contrast and percutaneous lysis of adhesions.
• 62267—A new code for “Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes”
• 62287—Revised to exclude the aspiration of the disk. The code now reads, “Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method, single or multiple levels, lumbar (eg, manual or automated percutaneous discectomy, percutaneous laser discectomy).”
• 63020, 63030, 63035—Revised to include both open and endoscopically assisted approaches for cervical and lumbar nerve root decompression procedures

Category III codes
A new symbol—the hollow circle (○)—appears in CPT 2009 and applies to Category III codes that have been recycled or reinstated. This symbol applies to Category III codes 0054T (computer assisted navigation with fluoroscopic images) and 0055T (imageless computer assisted navigation). These codes began as Category III codes, were assigned CPT codes in 2008, and have been reinstated as Category III codes in 2009.

Two new Category III codes describe a new technique that involves both a unique approach and surgical technique for lumbar fusion, and for the treatment of lumbar degenerative disk, annular tear, low back pain, and spondylolisthesis. Per the Guidelines, the anterior fusion, instrumentation or image guidance may not be reported in addition to these procedures.

• 0195T—Arthrodesis, pre-sacral interbody technique, including instrumentation, imaging (when performed), and discectomy to prepare interspace, lumbar; single interspace
• 0196T—Each additional interspace (List separately in addition to code for primary procedure.)

Additional Category III codes revisions include the following:

• 0092T, 0095T, and 0098T—Guideline changes with cross references to the new CPT codes for the additional inter­spaces for cervical arthroplasty procedures
• 0163T, 0164T, and 0165T—Guideline changes with cross references to the new CPT codes for the additional interspaces for cervical arthroplasty procedures

E&M code changes
The first change can be found on page 1 of the CPT 2009 Professional Edition, under “Definitions of Commonly Used Terms,” and is designed to clarify that health care professionals other than physicians may report services using the E&M codes when appropriate.

The specific instruction states, “Certain key words and phrases are used throughout the E&M section. The following definitions are intended to reduce the potential for differing interpretations and to increase the consistency of reporting by physicians in differ­ing specialties. E&M services may also be reported by other qualified health care professionals who are authorized to perform such services within their practice.”

In the sections on “Critical Care,” review and note the following changes:

• Definition of age-appropriate and location-appropriate services
• Transportation of critically ill or critically injured patients older than 24 months of age
• Discussion of time and inclusion/exclusion from critical care activities
• Deletion of CPT codes 99293-99300

Under “Prolonged Services,” changes have been made to the definition and instructions on the timing and use of the prolonged service codes, in addition to E&M service codes. Codes may be reported one time per day as appropriate. Additional E&M changes were made in the section on “New­born and Pediatric Critical Care.”

In the “Integumentary” section, Guideline changes have been made in the following areas: Skin replacement and skin substitutes; intermediate repair codes (wording changed from “Layered closure of wounds…” to “Repair, intermediate, wounds of…”); and flaps (to clarify the definition of delay transfer of flaps).

Mary LeGrand, RN, MA, CCS-P, CPC, is a consultant with KarenZupko & Associates. The information in this article has been reviewed by members of the AAOS Coding, Coverage, and Reimbursement Committee. If you have coding questions or would like to see a coding column on a specific topic, e-mail aaoscomm@aaos.org