Frequently asked questions and answers

Q: We read the article on coding for pediatric spine fusion (AAOS Now, August 2008) with interest. We are not sure we have been counting segments the way it was described in the article.

A: Many questions were submitted about this article, which was verified for accuracy by representatives from the AAOS, the North American Spine Society, and American Association of Neurological Surgeons. Although the definition of the codes appears different than that for traditional fusion codes, the codes were valued to include two vertebrae for each “fused segment.” The AAOS Coding, Coverage, and Reimbursement Committee has sought clarification from the American Medical Association (AMA) to see whether the need for a guideline exists or to redefine the codes. As more information becomes available, it will be covered in AAOS Now.

Rotator cuff repair or reconstruction
Q: Our surgeon performed and documented an arthroscopic acromioplasty, with limited débridement of the labrum, followed by an open rotator cuff repair of the subscapularis and supraspinatus tendons at the same session. The surgeon believes this should be reported with CPT code 23420, but the coding staff says the documentation supports a repair. There are three different diagnoses for the procedures documented in the operative note.

A: You are correct to raise this question. CPT Code 23420—Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)—should be reported when the surgeon reconstructs a massive rotator cuff tear requiring extensive releases and mobilization of tissue. In this case, CPT code 23420 includes the intra-articular débridement and the subacromial decompression/acromioplasty. However, correct coding for the arthroscopic intra-articular débridement, arthroscopic subacromial decompression, and open rotator cuff repair that you describe is as follows:

• 23410 or 23412—Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute (23410) or chronic (23412)
• 29826-59—Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with or without coracoacromial release
• 29822-59—Arthroscopy, shoulder, surgical; débridement, limited

Remember to link the appropriate diagnosis code to each procedure.

External fixator adjustment
Q: The surgeon documented that she had to manipulate/adjust the patient’s external fixation device. This was done in the office and the patient is no longer in the global period. How do we report this service?

A: Because the service was performed in the office and the patient is outside of the global period, the work is included in the evaluation and management (E/M) service, assuming the surgeon performed and documented a reportable E/M service. CPT code 20693—Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] and/or new ring[s] or bar[s])—is only reportable if the revision/adjustment is performed in the operating room under anesthesia.

Arthroscopic ACL débridement
Q: Which CPT code should be used to report an arthroscopic anterior cruciate ligament (ACL) débridement?

A: Report this procedure using CPT code 29999—Unlisted procedure, arthroscopy.

Distal radius fracture and external fixator
Q: How do you report the open reduction of an extra-articular distal radius fracture and the application of a uniplane external fixator?

A: Report the services as follows:

• 25607—Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation
• 20690-51—Application of a uniplane (pins or wires in one plane), unilateral, external fixation system

Remember, CPT code 20690 is no longer a modifier 51-exempt CPT code. Payment will be reduced according to the payor’s multiple procedure payment formula.

Cages—once or twice per interspace?
Q: Are cages placed bilaterally during an interbody fusion reported once or twice for the fusion?

A: CPT code 22851—Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure)—is reported one time per interspace. In 2009, the status of this code was changed from a modifier 51-exempt code to an add-on code. The code should be reimbursed at 100 percent when reported. If cages are placed at multiple interspaces, report 22851 for the first interspace and 22851-59 for each additional interspace.

One, two, or three compartments?
Q: We were told that, for the purposes of coding, we could report an intra-articular débridement, subacromial decompression, and débridement in the acromioclavicular (AC) joint all together because the AC joint is a separate compartment in the shoulder. Do you agree?

A: Although the AC joint is a separate anatomic location and it is appropriate to report a distal clavicle resection with the above combination, the débridement in the AC joint is not separately reportable. For the purposes of coding, an intra-articular débridement may be reported if it is not an integral part of other services performed at the same time. Débridement in the subacromial space is reportable if a more extensive procedure is not performed in that anatomic location.

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