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.
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.)
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.)
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:
22586—Arthrodesis, pre-sacral inter-body technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace
0309T—Arthrodesis, pre-sacral inter-body technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft, when performed, lumbar, L4-L5 interspace (Billing Note: List 0309T separately in addition to code for the primary procedure 22586)
23473 – Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component.
23474 – Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component.
24370 – Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component.
24371 – Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component.
(Billing Note: Guideline instructions related to the reporting of electromyograms (EMGs) and nerve conduction studies (NCS) are found in the beginning of their respective CPT sections.)
CPT codes 95900–95904 were deleted and replaced by the following CPT codes:
95907—Nerve conduction studies; 1–2 studies
95908—Nerve conduction studies; 3–4 studies
95909—Nerve conduction studies; 5–6 studies
95910—Nerve conduction studies; 7–8 studies
95911—Nerve conduction studies; 9–10 studies
95912—Nerve conduction studies; 11–12 studies
95913—Nerve conduction studies; 13 or more studies
Extracorporeal Shock Wave: Wound Healing
Two new Category III codes for extracorporeal shock wave for wound healing were introduced:
0299T—Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound
0300T—Each additional wound (Billing Note: List separately in addition to code for primary procedure.)