By Matthew Twetten

New look, updated contents

Published annually by the AAOS since 1991, the GSD was conceived as a tool to help orthopaedic surgeons and their office staff code and bill providers appropriately for the services they render. The guide is edited by members of the AAOS Coding, Coverage, and Reimbursement Committee, c haired by Blair C. Filler, MD.

The GSD features individual entries for virtually every integumentary, musculoskeletal, and nervous system Current Procedural Terminology (CPT®) code. It then instructs users on what procedures are considered included, or bundled, and what procedures are considered excluded, or unbundled.

“The value of the GSD is that it tells users which intra-operative services can be billed separately and which cannot,” explained Dr. Filler. “AAOS members who follow GSD recommendations should be able to significantly improve their revenue. Not only will they be able to reduce the number of denials they get from payors for services considered bundled, they’ll also have a resource to use in appealing inappropriate payor denials.”

Why the new format?
Dr. Filler and other committee members believed that the GSD’s format had become outdated and that a complete review was necessary to enhance its value for AAOS members.

“The GSD is the cornerstone of the Academy’s coding products—including Code X—and we take great pride in the popularity of the guide with our membership,” said committee member M. Bradford Henley, MD, MBA. “We felt we could provide a significant service by making the guide more detailed and by making sure the information in the book is aligned with current standards in orthopaedic surgery.”

Annually adding entries for CPT codes that were new for a particular year had resulted in very slight variations in different sections of earlier editions of the GSD. These variations led to some confusion, especially when otherwise nearly identical codes would have different inclusions and/or exclusions.

Previous GSD editions also relied on a template that listed the same 10 or 11 inclusions and three exclusions for every CPT code listed. Some of these “generic” inclusions or exclusions clearly didn’t apply, however, such as in the case of CPT codes for closed fracture treatment. In previous GSD editions, an entry for a closed fracture treatment would list all 11 generic inclusions, when only four were truly applicable.

“The surplus or redundant information in some GSD entries was clearly confusing and unnecessary,” said Richard J. Friedman, MD, who represents the American Shoulder and Elbow Surgeons on the committee. “Why list inclusions on suture removal, closure, or other steps that would never be taken in closed treatment of a fracture or injection procedures? The 2010 edition has only the information that billers and surgeons need to clearly understand what’s included in each code.”

Another reason for the GSD’s redesign was based on the committee’s recognition that many government and commercial payors utilize the GSD in formulating their policies on what is and what is not deemed to be bundled into a particular service. Ensuring that the GSD was completely accurate so that providers can be confident they are using the same standards as their payors was imperative.

Payors are also becoming increasingly aggressive in seeking justification from providers for the services the provider bills. An updated GSD, when combined with documentation from the CPT^® 2010 Professional Edition, will provide AAOS members with a definitive explanation for their billing if and when payors seek further explanation.

“The number of practice audits is increasing; our members must have a source that is completely current and accurate and can help them reduce the risk of audits,” said committee member R. Dale Blasier, MD. “The committee reviewed all 1,500-plus codes listed in the GSD and eliminated any inclusions or exclusions deemed unnecessary, redundant, or confusing. This was extremely time-consuming, but definitely worth the effort.”

Changes for the better
The 2010 GSD eliminates the generic templates so that every entry is tailored to the specific CPT code and does not contain any extraneous or potentially contradictory information. This will make the GSD easier to use and more logical.

“Replacing generic inclusions and exclusions with procedure-specific inclusions and exclusions is the single biggest value-added change to the 2010 version,” Dr. Henley said.

Another major change is the standardization of language throughout the GSD. This is important because payors rely on a standard language when it comes to determining payment policies. A single word could make a difference in a payor’s interpretation of a claim.

Consider, for example, the difference between “removal of loose or foreign body greater than 5 mm and/or through a separate fascial incision” and “removal of loose or foreign body greater than 5 mm or through a separate fascial incision.” This effort at standardization is also consistent with efforts by the American Medical Association (AMA) to standardize wording in its master CPT guide.

“The entire revision effort was designed to make every GSD entry correct to that entry and only that entry,” said Dr. Henley. “We think the revised version will be better for everyone—providers and payors alike—and we encourage everyone to check out the new edition.”

The AAOS Complete Global Service Data for Orthopaedic Surgery, as well as Orthopaedic Code-X, can be ordered online; visit www.aaos.org/store and search “coding resources.”

Matthew Twetten is the AAOS senior health policy analyst and staff liaison to the AAOS Coding, Coverage, and Reimbursement Committee. He can be reached at twetten@aaos.org