Lecture Notes to Accompany Jean Jurek Stacey Mosay

Outline Arthroscopy and Endoscopy Shoulder, Elbow, and Wrist Hand Hip Knee Foot Copyright ©

Learning Outcomes After completing this presentation, you should be able to: 1. Assign codes

Arthroscopy and Endoscopy Codes (29800 -29999) Copyright © F. A. Davis 2018 4

Diagnostic Endoscopy and Arthroscopy Diagnostic Arthroscopy Performed during surgical arthroscopy Performed to determine the

Diagnostic arthroscopies should not be coded when a surgical arthroscopy is performed. (True or

Shoulder, Elbow, and Wrist Copyright © F. A. Davis 2018 7

Shoulder Procedures Treatment: Code(s) Rotator cuff syndrome Coding Open: 23410– 23420 Arthroscopically: 29827 Impingement

Impingement syndrome can be treated____. (Choose all that apply. ) A. With a coracoacromial

Elbow Procedures Bursectomy Located between the ulna and skin at the posterior tip of

Wrist Procedures Treatment: Code(s) Arthroscopy Synovectomy for arthritis or synovitis: 29844 Debridement of arthritis:

Common Disorders and Procedures on the Hand Treatment: Code(s) Dupuytren’s contracture repair Fasciotomy: 26040

Hand Joint Arthroplasty The carpal bones of the hand are subject to wear and

The extensor tendons of the hand are superficial and highly susceptible to injury from

Common Disorders and Procedures on the Hip Procedure: Code(s) Arthroplasty 1. 2. Arthroplasty revisions

Common Knee Injuries and Procedures Procedure: Code(s) Repair meniscus: 29882 or 29883 Meniscectomy: 29880

Arthroplasty Total Knee Replacement (TKR) Midline incision over knee and dissected down to expose

Before assigning a code to knee arthroplasty, the coder should obtain the answers to

Common Podiatric Surgeries and Conditions Procedure: Code(s) Bunion correction Keller, Mayo, or Mc. Bride

The correct term for the abnormal enlargement of the metatarsal phalangeal joint (MPJ) of

Chapter Summary Musculoskeletal procedures affect soft tissue, tendons, ligaments, muscle, cartilage, and bone. Assigning

Copyright © 2018 by F. A. Davis Company. All rights reserved. This product is

Credits Editor-in-Chief: Margaret Biblis Senior Acquisitions Editor: Quincy Mc. Donald Developmental Editor: Amelia L.

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Lecture Notes to Accompany Jean Jurek Stacey Mosay Daphne Neris CPT Surgery: Musculoskeletal System Chapter 18 Part 2

Learning Outcomes After completing this presentation, you should be able to: 1. Assign codes for procedures commonly performed on the muscles, bones, and joints. 2. Recognize when to use modifiers when coding orthopedic services. 3. Determine intraoperative services and imaging guidance work for orthopedic procedures and know when they are separately reportable. 4. Define common musculoskeletal system surgical techniques. 5. Understand the physical structure of the spine and its coding guidelines. 6. Describe the guidelines for coding fractures and explain the correct assignment of casting/strapping codes. 7. Describe the guidelines for the use of codes in the endoscopy/arthroscopy section of the musculoskeletal surgery codes in CPT. 8. Assign codes for common shoulder, elbow, and wrist procedures. 9. Discriminate between flexor and extensor tendons of the hand, describing common tendon repair procedures. 10. Assign codes for hip arthroplasty based on the components used. 11. Identify the compartments of the knee and assign arthroscopic procedure codes based on these structures. 12. Describe the differences between common bunionectomy techniques. Copyright © F. A. Davis 2018 3

Diagnostic Endoscopy and Arthroscopy Diagnostic Arthroscopy Performed during surgical arthroscopy Performed to determine the best course of treatment; results in open surgical procedure Could not be completed arthroscopically, resulting in open procedure To visualize the joint and the extent of the injury before deciding if treatment can be adequately carried out arthroscopically and subsequently performs an open procedure Copyright © F. A. Davis 2018 Coding Not coded; code only surgical Use modifier – 59 to indicate distinct diagnostic service Only open procedure coded Code diagnostic arthroscopy separately with modifier – 51 5

Diagnostic arthroscopies should not be coded when a surgical arthroscopy is performed. (True or False? ) A. True B. False

Shoulder Procedures Treatment: Code(s) Rotator cuff syndrome Coding Open: 23410– 23420 Arthroscopically: 29827 Impingement syndrome Coracoacromial ligament release: 23130 or 23415 Included in subacromial decompression: 29826 Open acromioplasty or acromionectomy: 23130 Copyright © F. A. Davis 2018 Adhesive capsulitis Manipulation: 23700 Lysis of adhesions: 29825 Both manipulation and lysis of adhesions: (Code for whichever is more extensive. ) Shoulder instability: 29999 SLAP lesion repair: 29807 Bankart lesion repair: 29806 (as well as a code for repair of any labral lesion 29807) 8

Impingement syndrome can be treated____. (Choose all that apply. ) A. With a coracoacromial ligament release B. During arthroscopic subacromial decompression C. With manipulation under anesthesia D. With open acromioplasty or acromionectomy

Elbow Procedures Bursectomy Located between the ulna and skin at the posterior tip of the elbow Olecranon bursa allows for skin to glide easily over bone Excision of olecranon bursa code 24105 Copyright © F. A. Davis 2018 Tennis (Golfer’s) Elbow Repair Lateral, or outer, side of elbow Tear may also be medial Three surgical procedures in range 24357– 24359 10

Wrist Procedures Treatment: Code(s) Arthroscopy Synovectomy for arthritis or synovitis: 29844 Debridement of arthritis: 29846 Carpal tunnel release (CTR) Title De Quervain’s release: 25000 Colles fracture: 25600 Ganglion cyst excision: 25111– 25112 Open carpal tunnel release: 64721 Arthroscopic carpal tunnel release: 29848 Copyright © F. A. Davis 2018 11

Common Disorders and Procedures on the Hand Treatment: Code(s) Dupuytren’s contracture repair Fasciotomy: 26040 or 26045 Extensive fasciectomy: 26121 to 26125 Ganglion cyst: 26160 Amputation: 26952 Replantation of finger: 20816– 20827 Tendon repairs: 25000– 25025 Copyright © F. A. Davis 2018 Tendon grafts One-stage grafting: 26358 Two-stage grafting Flexor tendons: 26390 and 26392 Extensor tendons: 26415 and 26416 Tendon pulley Tenosynovectomy and excision: 26145 Pulley release: 26055 Reconstruction Primary tendon repair: 26356 First-stage reconstruction: 26390 or 26415 Second-stage reconstruction: 26392 or 26416 13

Hand Joint Arthroplasty The carpal bones of the hand are subject to wear and tear from age and degeneration from arthritis. These bones can be replaced with artificial joints as a last resort treatment. Arthroplasty does entail the creation of an artificial joint, but it also can pertain to an operation that as much as possible restores the integrity and functionality of a joint. Hand arthroplasty codes: 25441– 25449 Copyright © F. A. Davis 2018 14

The extensor tendons of the hand are superficial and highly susceptible to injury from lacerations, bites, burns, or blunt trauma. Extensor tendon repair is more technical and difficult than flexor repairs because extensor muscles are stronger and require more secure suturing for initial attachment. (True or False? ) A. True B. False

Common Disorders and Procedures on the Hip Procedure: Code(s) Arthroplasty 1. 2. Arthroplasty revisions Hemiarthroplasty: 27125 Total hip replacement: 27130 Conversion of previous hip surgery to total hip arthroplasty: 27132 Code Assignment Revision of THA, both components: 27134 Revision of THA, acetabular component only: 27137 Revision of THA, femoral component only: 27138 Girdlestone salvage procedure: 27122 Copyright © F. A. Davis 2018 3. 4. Before assigning a code, ask: Is this procedure an initial or revision arthroplasty? Is this a total or partial replacement? What components are replaced? Is this a conversion of a previous hip fracture reduction to a prosthetic joint? 17

Common Knee Injuries and Procedures Procedure: Code(s) Repair meniscus: 29882 or 29883 Meniscectomy: 29880 or 29881 Chondroplasty: 29877 Repair of ligament tears: 29888 or 29889 Synovectomy: 29875 or 29876 Copyright © F. A. Davis 2018 Plica syndrome: 29875 Osteochondritis dissecans treatment: 29885– 29887 Treatment of arthritis Abrasion arthroplasty: 29879 Osteochondral autograft transfer system (OATS): 29866 19

Arthroplasty Total Knee Replacement (TKR) Midline incision over knee and dissected down to expose knee joint Jig used to remove both femoral condyles and medial and lateral compartments of tibial joint surface Damaged cartilage on joint surface of patella removed Prosthesis placed Tibial and femoral components secured with glue or bone screws Hemiarthroplasty: 27446 Total knee: 27447 with –RT or –LT modifier Copyright © F. A. Davis 2018 Arthroplasty Revisions Failure of TKR requires revision to only one component: 27486 Failure of TKR requires revision to entire knee: 27487 If the knee fails during the global period of the initial placement, use modifier – 78 with these codes. 20

Before assigning a code to knee arthroplasty, the coder should obtain the answers to the following questions: (Choose all that apply. ) A. Is this procedure an initial or revision arthroplasty? B. Is this a total or partial replacement? C. If partial, which compartment is replaced? D. For revisions, is it one component or all components?

Common Podiatric Surgeries and Conditions Procedure: Code(s) Bunion correction Keller, Mayo, or Mc. Bride bunionectomy: 28292 Joplin procedure: 28294 Mitchell, Chevron, Concentric (modified Mc. Bride), and Austin (Reverdin-Green): 28296 Akin osteotomy (phalanx osteotomy): 28298 Double osteotomy: 28299 Hammertoe repair General: 28285 Fifth toe: 28296 Copyright © F. A. Davis 2018 Cheilectomy: 28289 Fusing joint or osteotomies: 28750 Plantar fasciitis treatment Ostectomy, partial excision (bunionette): 28110 Hallux rigidus repair Incised or excised: 28008 or 28060, 28062, 28250, 29893 Shock wave: 28890 Treatment of Morton’s neuroma: 28080 Heel spur surgery: 28119 Exostosis: 28288, 28290 Repair of tarsal tunnel syndrome: 28035 23

The correct term for the abnormal enlargement of the metatarsal phalangeal joint (MPJ) of the great toe is _____. A. Bunion B. Hammertoe C. Hallux valgus D. Hallux varus

Chapter Summary Musculoskeletal procedures affect soft tissue, tendons, ligaments, muscle, cartilage, and bone. Assigning codes for procedures commonly performed on the muscles, bones, and joints requires familiarity with the organizational format of this subsection and a thorough understanding of anatomy and terminology. AAOS has identified 11 intraoperative services that should not be coded separately for orthopedic procedures. Reporting imaging guidance requires a review of CPT and CCI guidelines. Fracture guidelines are located in the beginning of the Musculoskeletal section. Codes are assigned based on the type of fracture treatment, not the fracture type. There are three types of fracture treatment: closed, open, and percutaneous skeletal fixation. Copyright © F. A. Davis 2018 Arthroscopy and endoscopy codes are located at the end of the Musculoskeletal section under codes 29800– 29999. Extensor tendons are located on the dorsum (or back) of the hand. Flexor tendons are located on the palm of the hand. Codes for tendon repair are assigned based on the technique used and whether the repair is a primary or secondary repair. Hip arthroplasty codes are assigned based on whether it is the initial or revision arthroplasty and whether it is a total or partial replacement. Recognizing anatomical landmarks for arthroscopic knee surgery is critical to adherence to coding guidelines. Knee arthroplasty codes are assigned based on whether the procedure is an initial or revision arthroplasty, and whether it is a total or partial replacement. 25

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Credits Editor-in-Chief: Margaret Biblis Senior Acquisitions Editor: Quincy Mc. Donald Developmental Editor: Amelia L. Blevins Production Manager: Bob Butler Director, Digital Solutions: Kirk Pedrick Developed by Cognition catalysts, helping customers enhance content and empower learners The publisher is not responsible for errors of omission or for consequences from application of information in this presentation, and makes no warranty, expressed or implied, in regard to its content. Any practice described in this presentation should be applied by the reader in accordance with professional standards of care used with regard to the unique circumstances that may apply in each situation. Copyright © F. A. Davis 2018 27