Orthopedic Coding Changes for 2012 Vertebroplasty

Orthopedic Coding Changes for 2012

Lynn M. Anderanin, CPC,CPC-I, COSC

Vertebroplasty

2011 2012 22520- Percutaneous 22520- Percutaneous vertebroplasty, 1 vertebral vertebroplasty, (bone body, unilateral or bilateral biopsy included when injection; thoracic performed), 1 vertebral body, unilateral or bilateral injection; thoracic

Same revision to 22521 and 22522

1 Spinal Arthrodesis

22633- Arthrodesis combined posterior or posterior lateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression),single interspace and segment; lumbar

22634- each additional interspace and segment

Guidelines for 22614 and 22632 • Can be used with any of the following – 22600 (22614) – 22610 (22614) – 22612 – 22630 – 22633 – 22634

2 Posterior Arthrodesis

2011 2012 22610- Arthrodesis, 22610- Arthrodesis, posterior posterior or posterolateral or posterolateral technique, single level; technique, single level; thoracic (with or without thoracic (with lateral lateral transverse transverse technique technique) when performed)

Same revision to 22612

Percutaneous Discectomy

2011 2012 62287- Decompression procedure, 62287- Decompression procedure, percutaneous, of nucleus percutaneous, of nucleus pulposus of intervertebral disc, pulposus of intervertebral disc, any method utilizing needle based any method, single or multiple technique to remove disc material levels, lumbar (eg, manual or under fluoroscopic imaging or other form of indirect visualization automated percutaneous with the use of an endoscope, discectomy, percutaneous laser with discography and/or epidural discectomy) injection(s) at the treated level(s), when performed, single or multiple levels, lumbar

3 Percutaneous Laminotomy/Laminectomy

Effective July 1, 2011 0274T Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic 0275T lumbar

Laminotomy 2011 2012 63020- Laminotomy 63020- Laminotomy (hemilaminectomy), with (hemilaminotomy), with decompression of nerve root(s), decompression of nerve root(s), including partial facetectomy, including partial facetectomy, foraminotomy and/or excision of foraminotomy and/or excision of herniated intervertebral disc, herniated intervertebral disc; 1 including open and interspace, cervical endoscopically-assisted approaches; 1 interspace, cervical Same revision for 63030,63035

4 Spinal Instrumentation • When removing or revising instrumentation only the insertion should be reported – You can not report 22849, 22850, or 22852 with 22840-22848

Spinal Injection 2011 2012 62310- Injection, single (not via 62310- Injections of diagnostic or indwelling catheter), not including therapeutics substance(s) neurolytic substances, with or (including anesthetic without contrast (for either antispasmodic, opioid, steroid, localization or epidurography), of other solution), not including diagnostic or therapeutic neurolytic substances, including substance(s) (including needle or catheter placement, anesthetic, antispasmodic, opioid, includes contrast for steroid, other solution), epidural or localization when performed, subarachnoid; cervical or thoracic epidural or subarachnoid; cervical Same revisions to 62311 or thoracic

5 Paravertebral Facet Nerve Destruction

2011 2012 64626- Destruction by neurolytic agent, 64633- Destruction by neurolytic agent, paravertebral facet joint nerve; paravertebral facet joint nerve(s), with cervical or thoracic, single level imaging guidance (fluoroscopy or CT), cervical or thoracic, single facet joint 64627- Destruction by neurolytic agent, 64634- Destruction by neurolytic agent, paravertebral facet joint nerve; paravertebral facet joint nerve(s), with cervical or thoracic, each additional imaging guidance (fluoroscopy or CT), level (List separately in addition to cervical or thoracic, each additional code for primary procedure) facet joint, (list separately in addition to code for primary procedure

Paravertebral Facet Nerve Destruction

2011 2012 64622- Destruction by neurolytic agent, 64635- Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar paravertebral facet joint nerve(s), with or sacral, single level imaging guidance (fluoroscopy or CT), lumbar or sacral, single facet joint 64623- Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar 64636- Destruction by neurolytic agent, paravertebral facet joint nerve(s), with or sacral, each additional level (List imaging guidance (fluoroscopy or CT), separately in addition to code for lumbar or sacral, each additional facet primary procedure) joint, (list separately in addition to code for primary procedure)

6 Sacroiliac Joint Injection

2011 2012 27096- Injection procedure 27096- Injection procedure for sacroiliac joint, for sacroiliac joint, arthrography and/or anesthetic/steroid, with anesthetic/steroid image guidance (fluoroscopy or CT) including arthrography when performed 73542- Sacroiliac joint arthrography, has been deleted

Knee Arthroscopy

2011 2012 29880- Arthroscopy, knee, surgical; 29880- Arthroscopy, knee surgical; with meniscectomy (medial AND with meniscectomy (medial and lateral, including any meniscal lateral including any meniscal shaving) shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s) when performed Same revision for 29881

7 G0289 Arthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee

MY OPINION OF CHANGES

• Will not be reported with 29880-29881 • Will be reported with 29882-29883 • Will be reported for 29874 with 29880-29883

Arthroscopic Acromioplasty

2011 2012 29826- Arthroscopy, shoulder, + 29826- Arthroscopy, shoulder, surgical; decompression of surgical, decompression of subacromial space with partial subacromial space with partial acromioplasty, with or without acromioplasty with coracoacromial coracoacromial release ligament (i.e., arch) release, when performed (list separately in addition to code for primary procedure)

8 Multi-layer Compression System

2011 2012 29581- Application of multi- 29581- Application of multi- layer venous wound layer compression compression system, system; leg (below knee) below knee

New CPT® Codes for Compression Systems 29582- Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed

29583- upper arm and forearm

29584- upper arm, forearm, hand, and fingers

9 Xialfex® Injection

20527- Injection, enzyme (eg, Collagenase), palmar fascial cord (i.e., Dupuytren’s contracture) 26341- Manipulation, palmar fascial cord, (i.e., Dupuytren’s cord), post enzyme injection (eg, Collagenase), single cord

 HCPCS code for Xiaflex®- J0775

10 Spinal X-rays

2011 2012 72114- Radiologic 72114- Radiological examination, spine, examination, spine, lumbosacral; complete, lumbosacral; complete, including bending views including bending views, minimum of 6 views

Spinal X-rays

2011 2012 72120- Radiologic 72120- Radiologic examination, spine, examination, spine, lumbosacral, bending lumbosacral, bending views only, minimum of 4 views only, 2 or 3 views views

11 Deleted Bone Studies 77079- Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

77083- Radiographic absorptiometry (eg, photodensitometry, radiogrammetry), 1 or more sites

Tissue Cultured Autograft

2011 2012 15150- Tissue cultured 15150- Tissue cultured skin epidermal autograft, autograft, trunk, arms, trunk, arms, legs; first 25 legs; first 25 sq cm or less sq cm or less

Same revision to 15151-15157

12 New Codes to Skin Grafts

15271- Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area 15272- Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area or part thereof (list separately in addition to code for primary procedure) 15273- Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children 15274- Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure)

Additional Skin Graft Codes

15275- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area 15276- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area or part thereof (list separately in addition to primary procedure) 15277- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children 15278- Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof (list separately in addition to primary procedure)

13 Deleted Skin Grafts 15170-15171 15340-15341 15175-15176 15360-15361 15300-15301 15365-15366 15320-15321 15400-15401 15330-15331 15420-15421 15335-15336 15430-15431

E/M Changes • Initial Observation- Revised codes 99218-99220 • Prolonged Service- Revised codes 99354-99359