The following article is written by Rosalind Richmond, chief coding and compliance officer for GENASCIS.
CPT copyright 2010 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.
For 2011, CPT contained five new codes, 18 re-sequenced codes and 12 code revisions for the musculoskeletal section.
Let's start with the new cervical spinal procedure codes for CPT with a comparison to the ICD-9-CM revisions for cervical spinal surgery that were effective October 1, 2010.
CPT new cervical spinal codes 2011
These two new codes are used to report anterior interbody arthrodesis procedures, and discectomy performed at the same level as the arthrodesis is included. Arthrodesis procedures are performed as surgical fixation or fusion of a joint to reduce pain and improve stability.
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22551 |
Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 |
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+22552 |
cervical below C2, each additional interspace (List separately in addition to code for procedure) (Use 22552 in conjunction with 22551, do not use 69990 with 22552) |
Cervical spinal fusion (arthrodesis) is performed for indications such as herniated disc; degenerative, traumatic, and/or congenital lesions; or to stabilize fractures or dislocations of the spine. An anterior approach to reach damage vertebrae is performed; skull tong traction is also applied.
ICD-9-CM 2010 revised cervical spine codes
ICD-9-CM made changes involving the cervical spinal fusion codes last year. According to the Coding Clinic, Fourth Quarter 2010, changes were made effective Oct. 1, 2010 to clarify the use of the spinal fusion codes. Below is a recap of the changes. The primary change was the instruction notes that were added to subcategories 81.0 (Spinal fusion) and 81.3 (Re-fusion of spine).
The 2010 instructional notes provide information pertaining to the classification axis where the code titles were revised. The revision reflects the anatomic portion (anterior or posterior column) fused as well as the technique used.
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81.02 |
Other cervical fusion of the anterior column, or anterior technique |
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81.03 |
Other cervical fusion of the posterior column, posterior technique |
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81.32 |
Refusion of other cervical spine, anterior column, anterior technique |
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81.33 |
Refusion of other cervical spine, posterior column, posterior technique |
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Anterior Column – Fusion: The body (corpus) of adjacent vertevbrae is fused (interbody fusion). Technique: The anterior column can be fused using an anterior, lateral, or posterior technique. |
Posterior Column – Fusion: Posterior structures of adjacent vertebrae are fused (pedicle, lamina, facet, transverse process, or "gutter" fusion. Technique: A posterior column fusion can be performed using a posterior, posterolateral, or lateral technique. |
2010 ICD-9-CM spinal fusion index changes
Inclusion terms were created to provide additional coding guidance on procedures and techniques:
- DLIF – Direct lateral interbody fusion
- XLIF – Extreme lateral interbody fusion
- AxiaLIF – Extracavitary technique and facet fusion
Other 2010 ICD-9-CM Changes
Changes for ICD-9-CM last year also included code revisions for the dorsolumbar and lumbar spine. This information can be reviewed in the Coding Clinic, Fourth Quarter 2010.
CPT 2011 New Codes — Arthroscopic Hip Procedures
Three new codes are now available for reporting arthroscopic hip reconstruction procedures. The new additions include synovectomy and labral debridement/chondromplasty when performed at the same session.
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#29914 |
Arthroscopy, hip surgical; with femoroplasty (i.e., treatment of cam lesion |
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#29915 |
Arthroscopy, hip surgical; with acetabuloplasty (i.e., treatment of pincher lesion |
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#29916 |
Arthroscopy, hip surgical; with labral repair (Do not report 29914 and 29915 in conjunction with 29862 and 29863) This code is not reportable for labral repair secondary to acetabuloplasty. |
Note: # indicates these codes have been resequenced from 29800-29999.
Cam impingement: Cam impingement is the result of a femoral sided impingement. Motions such as hyperflexion and internal hip rotation can result in cartilage loss on the femoral head and acetabulum and labral tears or lesions. With loss of cartilage, this condition is considered a pre-arthritic condition. This condition is also referred to as a FAI (femoral-acetabular impingement).
Pincer impingement: Pincer impingement results from over coverage of the acetabulum. The extra bone repeatedly hits on the femoral neck, resulting in pinching of the labrum in between, known as a pincer lesion.
Combination of both cam and pincer impingements: Cam and pincer impingements can exist simultaneously, leading to cam lesions of the articular cartilage while the pincer lesions crush and tear the labrum.
CPT 2011 resequenced musculoskeletal codes
In 2010, the American Medical Association developed a re-sequencing system to assist with integrating new codes into existing code families regardless of the availability of sequential numbers.
Numbers assigned to some of the new CPT codes did not fit into the code family in numerical order. The symbol "#" indicates a resequenced code.
CPT 2011 revised codes
Below is a recap of the most prominent revisions made to codes in the Musculoskeletal Section.
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CPT 20005 – Revised to define the depth of the Incision and Drainage. |
CPT 22315 – Revised, by removing, "with or without anesthesia". |
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CPT 20664 – "Requiring anesthesia" removed. |
CPT 22851 – Revised, by removing, "threaded bone dowels". |
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CPT 20930 – Now includes, "osteopromotive material" |
CPT 27065 – "With or without" autograft was revised to "includes" autograft "when performed". |
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CPT 20931 – No longer a child code, now used to report structural allograft in spine surgery only. |
CPT 27066 – Subfacial was added, "with or without" was removed, "included" was added along with "when performed". |
CPT 2011 deleted codes
CPT code 20000 was deleted. For incision and drainage procedures, that do not involve the soft tissue below deep fascia (cutaneous or subcutaneous), refer to CPT codes 100060 and 10061.
References:
- AMA Corrections — www.ama-assn.org/ama1/pub/upload/mm/362/cpt-2011-corrections.pdf REV 3/10/11
- American Medical Association CPT 2011
- ICD-9-CM for Hospitals Volumes 1,2 & 3 2011
- AHA's Coding Clinic, Fourth Quarter 2010
Learn more about GENASCIS.
The information provided should be utilized for educational purposes only. Please consult with your billing and coding expert. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
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