AAOS Now

Published 12/1/2013
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Mary LeGrand, RN, MA, CCS-P, CPC

Coding Changes Will Hit Twice in 2014

CPT code changes you need to know about in January

Next year brings two sets of coding changes that orthopaedic surgeons and their staffs will have to know and incorporate into practice. The first change occurs with the traditional Current Procedural Terminology (CPT) code updates for new, revised, and deleted codes in January; the second change will be the introduction of the International Classification of Diseases, 10th edition, clinical modifications (ICD-10-CM) on Oct. 1, 2014.

This article highlights key orthopaedic-related code changes effective Jan. 1, 2014.

Evaluation and management
A new code set (CPT codes 99446–99449) has been added to the evaluation and management (E&M) codes to cover interprofessional telephone and Internet consultations.

The new E&M code set is described as follows: “An interprofessional telephone/Internet consultation is an assessment and management service in which a patient’s treating (eg, attending or primary) physician or other qualified health care professional requests the opinion and/or treatment advice of a physician with specific specialty expertise (the consultant) to assist the treating physician or other qualified health care professional in the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consultant.”

The following key points cover the use of these codes:

  • The code range is based on time and includes a verbal and written report to the treating or consulting physician.
    • 99446: 5–10 minutes of medical consultation discussion and review
    • 99447: 11–20 minutes of medical consultation discussion and review
    • 99448: 21–30 minutes of medical consultation discussion and review
    • 99449: 31 minutes or more of medical consultation discussion and review
  • Do not report these codes if a transfer of care occurs before the telephone/Internet discussion takes place.
  • Do not report these codes if the discussion results in an immediate transfer of care (eg, surgery) or if the transfer of care occurs within the next 14 days or at the next available appointment.
  • Do not report these codes if the telephone/Internet discussion lasts less than 5 minutes.
  • When calculating the length of time, include the review of pertinent medical records, laboratory studies, imaging studies, medication profile, or pathology specimens that may be required and transmitted electronically by fax or by mail immediately before the telephone/Internet consultation or following the consultation.
  • Document in the patient’s medical record the written or verbal request for telephone/Internet advice by the treating/requesting physician or other qualified healthcare professional, including the reason for the request. The documentation should conclude with a verbal opinion report and a written report from the consultant to the treating/requesting physician or other qualified healthcare professional.

Read the entire E&M section for full details related to this new code range. Practices will need to determine how documentation will occur to meet the requirements of a written report and the verbal report to the requesting provider.

Soft-tissue tumor guideline changes
The soft-tissue tumor codes, which may be reported for benign or malignant tumors, are found in CPT’s musculoskeletal section. These codes define tumors that are confined to the subcutaneous tissues (not skin, hence the rationale for their location in the musculoskeletal section), fascial or subfascial tumors, or radical resection of soft-tissue connective tissue tumors.

The guideline sections provide specific instructions to use CPT codes 11400–11446 for excision of benign lesions of cutaneous origin and CPT codes 11600–11646 for radical resection of tumor(s) of cutaneous origin, such as malignant melanomas. These guideline changes can be found throughout the musculoskeletal section and appear as revised codes secondary to the guideline changes.

Shoulder
The following CPT codes were deleted:

  • 23331—removal of foreign body; deep hardware (eg, Neer hemiarthroplasty)
  • 23332—removal of foreign body; complicated (eg, total shoulder)

The following three new shoulder codes were added:

  • 23333—removal of foreign body, shoulder; deep (subfascial or intramuscular)
  • 23334—removal of prosthesis, includes débridement and synovectomy when performed; humeral or glenoid component
  • 23335—removal of prosthesis, includes débridement and synovectomy when performed; humeral and glenoid components (eg, total shoulder)

CPT codes 23334 and 23335 may not be reported with the revision shoulder codes introduced in 2013 if a prosthesis is removed and replaced in the same shoulder in the same surgical session. Refer to CPT codes 23473 and 23474 for revision shoulder arthroplasty procedures.

Humerus and elbow
The following two codes and accompanying guideline changes were revised in the Humerus (upper arm) and Elbow section of CPT:

  • 24160—removal of prosthesis, includes débridement and synovectomy when performed; humeral and ulnar components
  • 24165—removal of prosthesis, includes débridement and synovectomy when performed; radial head

The following guideline changes are included:

  • References to CPT codes 25200 and 24201 for removal of foreign body of the elbow.
  • Use of CPT code 20680—removal of deep hardware for hardware removed from the distal humerus or proximal ulna, other than humeral and ulnar prosthesis.
  • CPT code 24160 may not be reported with revision elbow codes introduced in 2013 if a prosthesis is removed and replaced in the same elbow, same surgical setting. Refer to CPT codes 24370 and 24371 for revision elbow arthroplasty procedures.

Sacroiliac joint stabilization
In January 2013, the American Medical Association introduced Category III code 0334T—Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograft or allograft (structural or morselized), when performed, includes image guidance when performed (eg, CT or fluoroscopic). The new code was implemented on July 1, 2013, and appears in the 2014 CPT manual for the first time. This new code may be reported bilaterally with a modifier 50.

The introduction of this new code necessitated the addition of guideline changes to CPT codes 27216, 27218, and 27280. Note that CPT code 27280 describes an open sacroiliac joint arthrodesis while the Category III code defines a minimally invasive (indirect visualization) approach.

Chemodenervation
New chemodenervation codes (
Table 1) will help pediatric orthopaedic surgeons more accurately report services for spasticity. It is hoped that they also enable more accurate reimbursement with a decrease in denials and appeals.

Due to confusing terminology and instructions, CPT code 64614 was deleted and six new codes—including 4 primary and 2 add-on codes—were added with specificity for injections to the extremity versus the trunk muscles. Beginning Jan. 1, 2014, chemodenervation procedures will be reported per extremity (primary and add-on code) and based on the number of muscles (1–4 and 5 or more per extremity or 1–5 and 6 or more for the trunk).

Guideline changes were also introduced for electrostimulation and needle electromyography associated with the chemodenervation and other destruction by neurolytic agent codes. Refer to the CPT manual for CPT codes 95873 and 95874 for more information as appropriate. Remember that CPT codes 95873 and 95874 have both a professional and a technical component and require a modifier 26 if the procedure is performed in a facility setting.

Action steps

  • Update charge capture tools to reflect CPT code changes as appropriate.
  • Review changes with coding staff, physicians, and members of the appeals team to ensure that everyone understands the code changes.
  • Start focusing on ICD-10 education and documentation requirements. Although CPT codes are only introduced 3 months before their implementation date, ICD-10 implementation has been in the wings for more than 2 years. Be the engine and drive your practice to success on Oct. 1, 2014.

Mary LeGrand, RN, MA, CCS-P, CPC, is a nationally recognized coding and reimbursement expert who has been an instructor for AAOS for more than 12 years. This article has been reviewed by members of the AAOS Coding, Coverage, and Reimbursement Committee.