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Bill 15
| Question | Answer |
|---|---|
| If a Hip replacement arthroplasty is perform for medical reasons such as: Osteoarthritis is reported with | 27130 locaded subhead pelvis and hip join category repair revision andor reconstruction |
| If hip replacement is because of a fracture is reported with | 27236 located under subheading pelvis and hip joint category fracture and/or dislocation Fracture is not progressive degenerative disease was the reason for treatment. |
| Closed treatment: | used to describe procedures that treat fractures by on of three methods 1 without manipulation, 2 with manipulation, or 3 with or without traction |
| Manipulation is | attempted reduction, which is an attempt to maneuver the bone back into proper alighnment. The Dr. may bend, rotate, pull or guide the bone back into position. |
| Closed treatment without manipulation is a procedure in which the physician | immobilizes the bone with a splint, cast, or other device but without having to manipulate the fracture into alignment . Code 25500 describes closed tx of a radical shaft fx w/o manipulation |
| Initial castingor splinting services are | included in the fracture care, but the supplies used are not. Initial splinting or casting of fractures performed by another physician as the only service can be reported by that physician ie ER dr |
| Closed tx without manipulation example | when a pt has broken but stable radial shaft that is not displaced and the physician only applies a cast. |
| If cast needs to be removed and reapplied during the global period the surgeon that charged the global fee may report the cast/splin application with | 29000-29799 and append modifier -58 staged or related procedure/service. Only charge for cast removal w/o reapplication if the physician or physician group is not assuming care for the fracture. |
| Closed Treatment with manipulation is a procedure in which the dr has to | reduce/put back in place/ a fracture. Code 21320 describes a closed tx of a nasal bone fx with manipulation and stabilization. When pt has displced nose that requires manip to return it to the normal position |
| Code 21320 describes a closed tx of a nasal bone fx with manipulation and stabilization. When pt has displaced nose that requires manip to return it to the normal position The dr would then apply external and/or internal splints to | immobilized the nose |
| Open Treatment | is used when the fracture is open to the external environment. the fx bone is open to view and internal fixation pins, screws etc may use |
| Open Tx example Open tx of humeral tuberosity fx includes internal fixation when performed. The physician | opens the site, reduces the fracture, and applies internal fixation as needed to maintain anatomic position of the fracture. |
| Fractures are divided base on whether the fracture is pathological occured in an area of weakness or traumatic due to injury fractures | codes are reported with a 7th character to indicate whether the fracture care was intial or a susequent enounter open or closed. |
| Percutaneous skeletal fixation describes fracture treatment | that is neither open nor close in this procedure, the fracture is not open to view, but fixation pin screw is placed across the fracture site usually under x-ray imaging. |
| Example of percutaneous skeletal fixation ie great toe, phalanx , or pahalanges with manipulation 28496 This procedure is performed entirely | percutaneously |
| Proximal | closer to the body |
| distal | farther from the body |
| Open means the fracture | the fracture has broken through the bone cortex and the bone has been exposed to air/elements/ |
| Closed means the fracture | is not exposed to air healing was routine or delayed nonunion |
| Traction | is the application of pulling force to hold a bone in alignment fig 15-4 |
| Skeletal traction is the use of internal devices such as | pins , screws or wires. The devices are inserted into the bone through the skin with ends of the pins srews or wires sticking out through the skin so traction devices can be attached fig 15-5 |
| Skin traction involves | strapping, elastic wrap, or tape that is fastened to the skin or wrapped around the limb. weights are then attached to apply forc to the fracture 15-6 |
| Excision category 20150-20251 codes are for the | biopsies of muscle and bone The codes are divided based on the type of biopsy/buscle, bone, the depth of the biopsy superficial, deep and sometimes the method of optain the biopsy percutan |
| The procedure for a muscle or bone biopsy typically includes the | administration of local anesthetic into the biopsy area, an incision into area aloowing exposure of the muscle or bone, removal of tissue for biopsy and suturing of the area |
| Percutaneous biopsy 20206 differs in that the area is not | opened to physical view a trocar hollow needle or needle is placed into the muscle or bone by passing the needle through the skin and into the musccle or bone and withdrawing a sample |
| Biopsy codes of the general subheading are not to be reported for | the excision of tumors of muscle If the medical record indicates exciaion of a muscle tuomor you would have to choose a code from the correct musculoskeletal subsection |
| Ie 24071 excision of a tumor 3 cm or greater from the soft tissue of the upper arm or elbow. Biopsy codes do not include | the pathology workup that is performed on the sample. |
| sinus refers to | a cyst or abscess int=side teh body tract know as a fistula connecting to another surface internal to gut or external to the skin |
| Removal codes located int the introduction or removal category 20520-20525 report the | removal of a foreign body lodged in muscle or tendon |
| Injection in the removal category report injections made into | a tendon, ligament or ganglion cyst cystic tumor an example of the use of these injection codes would be a corticosteroid injection as a ganglion cyst treatment. |
| Arthrocentesis is | aspiraton of a joint 15-12 and the codes to report range of 20600-20611 the area over the involved joint is injected with anesthetic, a needle is inserted into the joint, and fluid is withdrawn. |
| New codes for athrocentesis procedures were created to include | ultrasound guidance codes 20604, 20606 and 20611 The existing arthrocentesis codes were revised to state not using ultasound guidance 20600 20605 20610 |
| ganglion cyst | which is a rubbery swelling that may occur anywhere on the body but usually occurs over a joint or tendon of the wrist or foot tx is surgical removal aspiration or aspiraton with injection of steroid |
| Ganglion cysts often appear in a cluster and if multiple cysts are treated report the service with | 20612 with modifier -59 appended. |
| Insertion of wires or pins to repair a bode 20650 after a traction devicew is attached to pins and wired to hold the bone to heal | is a procedure often used aby orthopedic physicians using a local or general anesthetic the bonde i sdrilled through with a power drill and pins and/or wires are placed through the hoesl in the bone and allowed to emerge gherough the skin on each side bn |
| ORIF | open reduction with internal fixation and uses pins, wires, and screws to stabilize a fractureWhen the application of these devices is performed through an Open surgical procedure |
| Implant removal codes 20670, 20680 are available for removal of | burie wires pins rod ect previously implanted if removed during the global period add modifer -58 staged according to implanted objects are superficial or deep |
| External fixaton is the applicaton of a device that holds a bone in p;lace unlike internal fixation the device is place | on teh outside of the body and pins or wires are place into the bone from the outside wires and pins are fastened to the bone hold the device or system imobileused commonly with comminuted fractures |
| The fixation device codes are rported in addition to the code for the treatment of the fracture unless | the code specifically states that fracture repair is included see code 25545 |
| Fascia lata grafts are taken from | the mid-upper lateral thigh area because the faxcia is thickest in this area |
| Fascia is the | fibrous tissue that serves as connective tissue it may be shaved off with an instrument called a stripper or it may be incised/cut/ away. The facia lata is then used in the repair procedure |
| Codes for obtaining the fascia lata graft are based on whether a stripper 20920 was used to remove the fascia or whether a | more complex removal procedure 20922 was required to obtain the graft material |
| Tissue Grafts | include obtaining of fat, dermis, paratenon/loose connective tissue from the tendon compartment/ and other tissue types |
| Spine Surgery codes 20930-20938 report | the obtaining and haping of the tissue, whether from the patient autograft or froma noor allograft. |
| The obtainig and shaping of the spine graft material is reported in additon to reporting the | implantation procedure which is the primary procdure definitive procedure unless the description of the major procedure includes a graft |
| Bone marrow aspiration for bone grafting 20939 is most commonly used for lumbar spinal fusiong only report cod 20939 in addition to the primary procedure and when performed with | spinal surgery. For bone marrow aspiraton not perfomed with spinal surgery reference code 20999 |
| Monitoring of intersitial fluid pressure 20950 is a procedure | in which the physician inserts a device into the muscle compartment to measure the pressure changes with the muscle. Increased pressure in the muscle due to accumulation of fluid causes the blood supply to be compromised. |
| Bone grafts 20955-20962 | are identified bythe site from wich the graft is obtained when the bone grafts are removed the small blood vessels ramin attached to the graft the graft is then inserted the blood vessels are attached to ve |
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