Published 2/1/2010
Mary LeGrand, RN, MA, CCS-P, CPC

C P T coding updates for 2010 – Par t 2

Casting, spinal codes, and new Category III codes

The 2010 Current Procedural Terminology (CPT®) Manual includes several new or revised sections pertinent to orthopaedic surgery. Each year brings with it several new orthopaedic-related CPT codes and guideline changes. Both are significant, and physicians, managers, and coding staff should pay attention to the guidelines for each section so that they are able to incorporate these instructions into daily coding practices.

Lower extremity casts
Code 29581 is a new code to report the application of a multi-layer venous wound compression system, below the knee. Do not report this code in conjunction with strapping of the ankles and/or foot or Unna boot CPT codes. It should be used to report treatment of chronic venous insufficiency with multi-layer compression products.

Spinal injections
CPT codes 22520-22521 (vertebral body, embolization, or injection) have been revalued to include conscious sedation. This means that conscious sedation is no longer a separately reportable service.

Surgery/Nervous System
Several changes of interest to orthopaedists have been made in this section. Four new codes related to spinal neurostimulators have been added (
Table 1). Multiple guideline changes were also made to define what is included in a neurostimulator sytem and to address procedures performed percutaneously or using an open approach.

In the section on Paravertebral Spinal Nerves and Branches, CPT codes 64470-64476 have been deleted and replaced by new codes 64490-64495 (Table 2). Additionally, guideline instructions have been added to address performing an injection with and without imaging. CPT codes 64490-64495 may be reported as bilateral procedures when medical necessity and documentation support the services. CPT codes 64492 and 64495, the add-on codes for the third and any additional levels, may only be reported one time per day.

Nerve conduction tests
CPT code 95905—Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report—is new. It was created to report nerve conduction tests when performed with preconfigured electrodes customized to a specific anatomic site. Guideline instructions related to reporting nerve conduction tests have also been introduced.

Because these codes have both a professional and a technical component, a separate report for the physician’s interpretative report is required.

Category III codes
Category III codes are temporary codes to report services that are considered to be emerging technology; they are also used to enable data collection. Once a Category III code is specified for a procedure, the physician may no longer report an unlisted code but must use the Category III code.

Medicare does not assign any relative value units to Category III codes, however, so the process for submitting these codes is similar to that used in reporting unlisted procedure codes.

The guidelines indicate which procedures may be reported as bilateral procedures and provide instructions on when the Category III code may be reported in addition to other service.

Table 3 shows the new Category III codes; you can also find them on the online list available at www.ama-assn.org

Next steps

  • The AAOS recommends that each orthopaedic office purchase and read the CPT Manual. The CPT® Professional Edition 2010 is available online at www.aaos.org/store.
  • Discuss the changes and how they will affect your practice with all appropriate internal staff.
  • Update your charge capture tools and practice management systems as appropriate.
  • Sending staff to a coding course may also be helpful.

Mary LeGrand, RN, MA, CCS-P, CPC, is a consultant with KarenZupko & Associates, Inc., and focuses on coding and reimbursement issues in orthopaedic practices.

If you have coding questions or would like to see a coding column on a specific topic, email aaoscomm@aaos.org