In 2015, orthopaedic coders will have to make changes based on several revisions to ICD-9 codes and guidelines as well as new orthopaedic-related CPT code information. Physicians and coders should review the entire 2015 CPT manual for guideline and code changes pertinent to their individual or group practices. This article introduces new orthopaedic-related CPT codes for 2015.
Joint injection codes
Three new joint injection codes (20604, 20606, and 20611) include the use of ultrasound guidance. As a result, descriptors for CPT codes 20600, 20605, and 20610 have changed.
Descriptors for CPT codes 20600, 20605, and 20610 now include the statement “without ultrasound guidance.” The new codes (20604, 20606, and 20611) include the descriptor, “with ultrasound guidance, with permanent recording and reporting.” These new codes specifically address ultrasound guidance and require that the report be included in the patient’s permanent record. Coders should check the guidelines for reporting 20600, 20605 or 20610 with fluoroscopic, computed tomography, or magnetic resonance imaging guidance.
Table 1 shows the changes and 2015 final relative value units (RVUs), as they were published in the Nov. 13, 2014, issue of the Federal Register.
CPT code 76942, Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation, may not be reported with any joint injection codes (20600, 20604, 20605, 20606, 20610 or 20611).
Radiofrequency and cryoablation of bone tumors
The musculoskeletal section of the 2015 CPT manual also includes a new indented code, 20983, for cryoablation of bone tumors and a revision to CPT code 20982, radiofrequency ablation, as shown in Table 2. Cryoablation is performed primarily by radiologists; less than 10 percent of services reported are performed by orthopaedic surgeons. CPT codes 20982 and 20983 are zero day global codes
Note: RVUs for the nonfacility expense are higher than those for the facility expense because all supplies and equipment are included in the payment when the procedure is performed in a nonfacility setting.
Open reduction of rib fractures
The introduction of three new CPT codes (21811–21813) for open treatment of rib fractures (Table 3) resulted in the deletion of two Category I CPT codes (21800 and 21810) and four Category III CPT codes (2045T-02487T).
These new codes should be reported by the orthopaedic surgeon when the rib fractures are managed by the orthopaedist. With the deletion of CPT code 21800, the management of uncomplicated closed rib fractures should be reported as part of Evaluation and Management (E&M) Services.
These new CPT codes have 0 global days, according to Addendum B published with the Final Rule. Subsequent visits will need to be billed separately.
Percutaneous vertebroplasty and vertebral augmentation
Vertebroplasty codes 22520–22522, 72291, and 72292 were deleted in 2015 as a result of Medicare’s 75 percent rule (meaning that the primary code and an image guidance code were reported together 75 percent of the time or more). This allowed the introduction of new vertebroplasty codes (22510–22512) that include image guidance. Similar changes occurred with the vertebral augmentation (kyphoplasty) codes with the introduction of codes 22513–22515 (Table 4).
Note that both sets of codes have an add-on code—22512 or 22515—that should be reported for each additional vertebral body along with the appropriate anatomic primary code. Two primary codes may not be reported together for the same procedure (eg, 22510 and 22511 cannot be reported together). Instead, the physician should report 22510 and 22512 when performing a percutaneous vertebroplasty at two vertebral bodies with the primary location being the cervicothoracic spine and the second vertebral body being cervicothoracic or lumbosacral.
CPT codes 22510, 22511, 22513, and 22514 have 10-day global periods. The global periods for 22512 and 22515 are associated with the respective primary procedure code.
The guideline stating that these procedures include bone biopsy and conscious sedation, if performed, has not changed. The new inclusion of image guidance precludes the separate reporting of any image guidance and CPT codes 72291 and 72292 have been eliminated in 2015. CPT instructs that sacral procedures are only reportable once per encounter.
Sacroiliac joint arthrodesis
The introduction of CPT code 27279, percutaneous or minimally invasive sacroiliac (SI) joint arthrodesis (Table 5), resulted in several changes.
First, the Category III code 0334T was deleted. Second, guideline changes were included for CPT codes 27216 and 27218 instructing the use of the new code (27279) when the procedure is not performed as an open, direct visualization procedure. Finally, CPT code 27280 was revised to include the terms “open” and also “including instrumentation.”
Total disk arthroplasty
A new CPT Category I code—22858, second-level cervical total disk arthroplasty—and a new Category III code—0375T, cervical disk arthroplasty procedure(s) performed at three or more levels—have been introduced in 2015 (Table 6). The creation of the new Category I code resulted in the deletion of Category III code 0092T.
If the surgeon performs a two-level disk arthroplasty, the surgeon should report 22856 and 22858. If the surgeon performs a four-level disk arthroplasty, he or she should report 22856, 22858, and 0375T.
Practices that offer pain management services, including the performance of abdominal plane blocks or rectus sheath blocks, should review the new codes 64486–64489, as well as guideline changes for CPT code 95887, nonextremity electromygraphy.
Review the entire CPT manual for changes specific to orthopaedics and other specialties within the practice.
Update charge capture tools and electronic health record references to include the new codes.
Ensure charges are created for all new and revised codes as appropriate.
Create “fees” for add-on codes to avoid additional work each time the procedure is performed and reported.
Ensure precertification and written authorization are part of surgical scheduling especially when reporting unlisted or Category III codes and procedures at risk for denial because they are considered experimental, investigational, or not medically necessary.
Review Code-X or the Global Service Data for the list of services considered “inclusive” or “exclusive” to all surgical procedures.
E&M services continue to be an area of focus. Although this section of CPT had no significant changes, the reporting of services independently or with surgical procedures must meet all documentation and coding requirements.
Mary LeGrand, RN, MA, CCS-P, CPC, is a senior consultant with KarenZupko & Associates, Inc., who focuses on coding and reimbursement issues in orthopaedic practices. Information in this article has been reviewed by members of the AAOS Coding, Coverage, and Reimbursement Committee.