Thursday, 12 January 2017

Orthopedic Surgery CPT Code Changes and Additions

These are the highlights of the seven CPT code changes and a listing of numerous CPT code additions affecting Orthopedic Surgery billing in 2013.  Make sure you review the full CPT manual for complete details of all coding changes to insure you receive your optimum claim reimbursements.
Spine CPT

Guideline Change: CPT codes 22633 and 22634 may be appropriately related as primary or index codes for spine bone grafts (20930–20938), instrumentation (22840–22844, 22848, 22845–22847), and intervertebral device (22851) codes.  

Bone marrow aspirate

Clarification: Use of bone graft codes (20930–20938) related to bone marrow aspiration. CPT code 38220 defines the work associated with the harvest of bone marrow for bone grafting only. (Billing Note: Category III code 0232T should be used when bone marrow aspiration is performed for platelet-rich stem cell.) 

Cervical Spinal Arthrodesis Guideline

Guidelines Added:  CPT codes 22554, 22585, 63075, and 63076; if the work associated with these procedures is performed during the same surgery by the same surgeon or by two separate surgeons/individuals during the same session, the correct codes are 22551 and 22552. (Billing Note: CPT codes 63075 and 22554 may not be unbundled and reported for the same patient, same session.)

Cast application

Guideline Change:  Refer to the section “Application and Strapping” for specific changes regarding the application of the first cast, its removal, coding by the individual who performs the initial service, and restorative management. (Billing Note: CPT code 29590 (Denis-Browne bar (splint) with manipulation and casting (eg, for metatarsus adductus, clubfoot) was deleted.)

Hip arthroscopy

Clarification: CPT code 29916 (Arthroscopic labral repair of a torn labrum) is considered inherent to CPT codes 29915, 29862, and 29863. (Billing Note:  CPT code 29916 should not be reported in addition to CPT codes 29915, 29862, or 29863 because the repair is already included in these codes, whether as a takedown and repair or a repair of an already torn labrum.) 


Guideline Change:   CPT code 64614 (Chemodenervation of muscle(s); extremity and/or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple sclerosis) may only be reported once per extremity. The parenthetical (s) was removed from extremity. (Billing Note:  CPT code 64614 states that modifier 50 should not be appended to this code. Check with your payers to determine specific rules to code submission.)

Intraoperative nerve monitoring

Clarification: Intraoperative nerve monitoring by the operating surgeon is included in the primary surgical service and is not separately reportable.

Update your medical billing system with the following new CPT codes for 2013: Spine

Get the Answers on New Payment Rules for 99215

FCSO detailed a new claim reimbursement process in it's December 2012 medical billing newsletter for CPT Code 99215.  See below for details:

What: Prepayment Review of E/M Code 99215

The Medicare fiscal intermediary First Coast Service Options, Inc. (FCSO), will be initiating a pre-payment review of 100 percent of the E/M Service Code 99215.

Where: Florida
Who: Certain Provider Specialties 

General practice
Osteopathic manipulative medicine
Pediatric medicine

When: Claims Submitted on or after January 18, 2013
Why: Conclusions of the OIG, CMS and FCSO

Upon examination of coding trends, the Office of the Inspector General (OIG) noted a 17% increase in the submission of E/M codes 99214 and 99215. As CMS agreed with their recommendations, efforts were initiated to encourage Medicare administrative contractors (MACs) to continue emphasizing the proper E/M scoring by providers billing these E/M services.

FCSO conducted it's own analysis that indicated a high risk of improper claim payment for certain specialties billing E/M code 99215 in Florida.

How: Receive Proper Claim Reimbursement for 99215

The CPT® manual defines code 99215 as follows:

Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components:

A comprehensive history
A comprehensive examination
Medical decision making of high complexity.

Usually the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. 

Billing Hint: Claims submitted with E/M code 99215 must be accompanied by documentation that justifies this level of medical necessity. By utilizing and E/M Scoresheet you can be assured of the accuracy of levels billed for your Evaluation and Management services.

Resources can be found at the following links: and

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