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Here are four tips for coding knee injuries and conditions from Teri Gatchel, MBA, CPC, of AAPC Physician Services.
1. Non-manipulative fracture coding. Coding for manipulative fractures is straightforward. the physician performs an "evaluation and management" services with a modifier 57 for the decision for surgery, then records the closed manipulation or open reduction for fracture care. However, it becomes complicated when physicians have an E/M service withaminimally displaced fracture and another type of injury. "The coder has to know whether they can report an E/M service and a fracture code for a minimally displaced or non-displaced fracture," says Ms. Gatchel. "If there is another isolated injury, which is a separate condition, then you can report the E/M services with the 25 modifier and report the separate condition. Technically there is no surgery, so therefore there is no decision for surgery and the 57 modifier is not applicable." (Note, some payors may want the 57 modifier based on the diagnosis)
If there are no other injuries, the coder has the option of reporting the global fracture code without the E&M service or reporting an E&M service by itself. "There's no other significant separately identifiable E&M service, supported by the history in the patient’s .medical record," she says.
2. Physicians' assistants performing fracture care. As some of you may be aware, several Medicare contractors have been denying reimbursement in error for Medicare patients when a physician's assistant performs fracture care. This edit was an oversight and should not affect the application of casts and the treatment of simple fractures. "Providers need to monitor denials closely for fracture care reported by the PA," says Ms. Gatchel. "Particularly, they should watch for denials for 90 day global fracture codes which is where most of the denials were coming from."
3. Chondroplasty. There is often confusion for coders when surgeons perform chondroplasty in addition to other procedures within the same knee. When the chondroplasty is done in the same compartment as the primary procedure, the two aren't coded separately. However, if the chondroplasty is done in a different compartment from the other procedure, they are separately billable. For example, a meniscal repair with chondroplasty in the same compartment requires one inclusive code, while medial meniscus repair and a patello-femoral chondroplasty are separately reported.
Medicare also requires a special G code, G0289, for reporting the separate procedure. Chondroplasty is reported as CPT 29877 itself, and the arthroscopic meniscal repair is 29882 for the medial or lateral repair.. "It's important to note that for Medicare, if chondroplasty is the only procedure you perform, you would just report the 29877 without the G code," says Ms. Gatchel. "The G code is only used to separately identify a separate compartment where there are other procedures in the knee."
4. Synvisc knee injections. There was a recent coding change in 2010 for synvisc knee injections with the J7325 code. "This code is to be used for synvisc injections regardless of whether the injection contains Synvisc or Synvisc-One," says Ms. Gatchel. Synvisc-One is a higher concentrated dose than sSynvisc, but the code remains the same. The difference comes in when you report the number of units associated with the code.
When the patient first receives an injection, report the 20610 code. For Synvisc-One, you report 48 units of the J7325 code for the single visit, instead of reporting a regular Synvisc injection that occurs over a series of three visits. For the regular Synvisc injection, report code J7325 with 16 units. In both instances, the number of units must be reported to receive reimbursement. "It's important to get the units correct because if you forget about the units you'll only be reimbursed for one," says Ms. Gatchel. "Since it's the same code, you need to be aware of how to report it correctly."
Learn more about AAPC Physicians Services.
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.
Related Articles on Orthopedic Coding:
3 Clarifications for Orthopedic Injection Coding
Denied CPT 64495: Q&A With Stacey Miller of GENASCIS
4 Shoulder Surgery Coding Challenges
Here are four tips for coding knee injuries and conditions from Teri Gatchel, MBA, CPC, of AAPC Physician Services.
1. Non-manipulative fracture coding. Coding for manipulative fractures is straightforward. the physician performs an "evaluation and management" services with a modifier 57 for the decision for surgery, then records the closed manipulation or open reduction for fracture care. However, it becomes complicated when physicians have an E/M service withaminimally displaced fracture and another type of injury. "The coder has to know whether they can report an E/M service and a fracture code for a minimally displaced or non-displaced fracture," says Ms. Gatchel. "If there is another isolated injury, which is a separate condition, then you can report the E/M services with the 25 modifier and report the separate condition. Technically there is no surgery, so therefore there is no decision for surgery and the 57 modifier is not applicable." (Note, some payors may want the 57 modifier based on the diagnosis)
If there are no other injuries, the coder has the option of reporting the global fracture code without the E&M service or reporting an E&M service by itself. "There's no other significant separately identifiable E&M service, supported by the history in the patient’s .medical record," she says.
2. Physicians' assistants performing fracture care. As some of you may be aware, several Medicare contractors have been denying reimbursement in error for Medicare patients when a physician's assistant performs fracture care. This edit was an oversight and should not affect the application of casts and the treatment of simple fractures. "Providers need to monitor denials closely for fracture care reported by the PA," says Ms. Gatchel. "Particularly, they should watch for denials for 90 day global fracture codes which is where most of the denials were coming from."
3. Chondroplasty. There is often confusion for coders when surgeons perform chondroplasty in addition to other procedures within the same knee. When the chondroplasty is done in the same compartment as the primary procedure, the two aren't coded separately. However, if the chondroplasty is done in a different compartment from the other procedure, they are separately billable. For example, a meniscal repair with chondroplasty in the same compartment requires one inclusive code, while medial meniscus repair and a patello-femoral chondroplasty are separately reported.
Medicare also requires a special G code, G0289, for reporting the separate procedure. Chondroplasty is reported as CPT 29877 itself, and the arthroscopic meniscal repair is 29882 for the medial or lateral repair.. "It's important to note that for Medicare, if chondroplasty is the only procedure you perform, you would just report the 29877 without the G code," says Ms. Gatchel. "The G code is only used to separately identify a separate compartment where there are other procedures in the knee."
4. Synvisc knee injections. There was a recent coding change in 2010 for synvisc knee injections with the J7325 code. "This code is to be used for synvisc injections regardless of whether the injection contains Synvisc or Synvisc-One," says Ms. Gatchel. Synvisc-One is a higher concentrated dose than sSynvisc, but the code remains the same. The difference comes in when you report the number of units associated with the code.
When the patient first receives an injection, report the 20610 code. For Synvisc-One, you report 48 units of the J7325 code for the single visit, instead of reporting a regular Synvisc injection that occurs over a series of three visits. For the regular Synvisc injection, report code J7325 with 16 units. In both instances, the number of units must be reported to receive reimbursement. "It's important to get the units correct because if you forget about the units you'll only be reimbursed for one," says Ms. Gatchel. "Since it's the same code, you need to be aware of how to report it correctly."
Learn more about AAPC Physicians Services.
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.
Related Articles on Orthopedic Coding:
3 Clarifications for Orthopedic Injection Coding
Denied CPT 64495: Q&A With Stacey Miller of GENASCIS
4 Shoulder Surgery Coding Challenges