Focus on tumor codes

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.

The 2010 Current Procedural Terminology (CPT®) Manual includes several new or revised sections pertinent to orthopaedic surgery. This article summarizes changes to excision of tumor codes, along with relevant instructions for integumentary coding. A follow-up article next month will review additional changes.

Symbol change
The 2010 CPT Manual—Professional Edition introduces a new symbol (#) to designate a resequenced code. The symbol will be used to identify resequenced codes that are out of numerical order; a reference placed numerically (eg, “Code is out of numerical sequence. See...”) will serve as a navigational alert directing the user to the location of the out-of-sequence code. A summary list of resequenced codes with a short explanation of resequencing appears in Appendix N.

This new symbol is being introduced with the addition, revision, and deletion of soft tissue and bone resection codes in the Musculoskeletal System section. It enables the placement of related concepts in appropriate locations within the families of codes regardless of the availability of numbers for sequential numeric placement.

Surgery/Integumentary system changes
Guideline changes have been made for lesions, adjacent tissue transfer and other flaps/grafts. Changes to the guidelines for excision of benign and malignant lesions focus on when it is appropriate to report closures separately and when the services are inclusive to each other.

Adjacent tissue transfer guideline changes reinforce that the excision of a lesion (codes 114xx–116xx) is included in the adjacent tissue transfer. They also describe the use of these codes in repairs in which the surgeon creates the flap. A traumatic wound that, by the nature of the injury, requires undermining of the adjacent tissue should not be reported using the adjacent tissue codes.

Guideline changes in “Other Flaps/Grafts” define the flaps and the use of neurovascular (NV) pedicle procedures when the flap includes skin and a motor or sensory nerve to reinnervate a structure, such as thumb injury requiring an NV flap for reconstruction/repair.

Surgery/Musculoskeletal system changes
For orthopaedics, the most significant changes are the introduction of new musculoskeletal soft tissue and bone resection CPT codes and the revision of current soft tissue and bone resection codes. Table 1 provides an overview of these new codes by anatomic location and tissue level.

The following four categories have been created; in the first three categories, codes are based on size (postexcision tumor size plus margin) and location:

• Excision of subcutaneous soft tissue tumors—Covers simple or marginal resection of tumors confined to the subcutaneous tissue below the skin but above the deep fascia. Includes simple and intermediate repair, but excludes “appreciable” vessel or neuroplasty repairs.
• Excision of fascial or subfascial soft tissue tumors—Covers resection of tumors confined to the tissue within or below the deep fascia, but not bone. Includes simple and intermediate repairs, but excludes “appreciable” vessel or neuroplasty repairs.
• Radical resection of soft tissue tumors—Covers resection of the tumor with wide margins of normal tissue. Includes resection of tissue from one or more layer (eg, subcutaneous, subfascial) but excludes “appreciable” vessel or neuroplasty repair or reconstruction.
• Radical resection of bone tumors—Covers resection of the tumor and wide margins. Includes resection of tissue from one or more layer (eg, subcutaneous, subfascial) but excludes “appreciable” vessel or neuroplasty repair and complex bone repair or reconstruction. These codes are based on location only, and typically will be reported for malignant or aggressive benign tumors.

Next steps

• AAOS recommends that each orthopaedic office purchase and read the CPT Manual. The CPT® Professional Edition 2010 is available online.
• 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 such as the one sponsored by the AAOS and presented by KarenZupko & Associates, Inc. may also be helpful.

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

Editor’s note: This is the first of a two-part article on updates to Current Procedural Terminology (CPT®) codes. In addition to the changes covered in this column, see this month’s cover story, “CMS eliminates reimbursement for Medicare consultation services” for more information on coding changes effective Jan. 1, 2010.

Additional coding changes will be covered next month.