PAYMENT IMPLICATIONS Changes to the CPT code set will impact surgical centers using the October 2012 Medicare ASC payment rates.

Here are a few recent changes to CPT coding guidelines that your coders might not know about. To ensure that your facility submits clean claims and optimizes revenue, make your coders aware of these changes.

Orthopedic surgery
• Arthroscopic meniscal trephination. Assign unlisted code 29999 for arthroscopic meniscal trephination. This procedure, more commonly known as microfracture surgery, is performed by drilling multiple holes in the torn part of the meniscus to promote bleeding, which enhances the healing process. This procedure is used for stable tears located on the periphery of the meniscus and joint capsule junction, where there is good blood supply (AMA, December 2011).

Code: 29999, Unlisted procedure, arthroscopy
Medicare ASC Reimbursement:None

• Arthroscopic subacromial decompression. When performed without partial acromioplasty or coracoacromial ligament release, you can't report it with code 29826. Assign code 29822 if the arthroscopic subacromial decompression involves debridement of soft tissue and bone removal. Assign code 29823 if there is extensive work done in the removal of the soft tissue and bone. The AMA did not define the term "extensive" in the guideline, so orthopedic surgeons at your ASC should have internal criteria for what constitutes extensive shoulder debridement (AMA, April 2012).

Code: 29822, Arthroscopy, shoulder, surgical;
debridement, limited
Medicare ASC Reimbursement:$1,198.06

Code: 29823, Arthroscopy, shoulder, surgical;
debridement, extensive
Medicare ASC Reimbursement:$2,303.22

• Flexor tenosynovectomy and carpal tunnel repair. If a patient has a diagnosis of carpal tunnel syndrome, a separate pathologic diagnosis such as rheumatoid arthritis or tenosynovitis, and both a flexor tenosynovectomy and carpal tunnel repair are performed, report code 25115 in addition to the carpal tunnel repair code (AMA, June 2012).

Code: 25115, Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (e.g., tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors
Medicare ASC Reimbursement:$891.88

Pain management
• Injection of spinal hardware sites. Report fluoroscopic-guided steroid and/or anesthetic injection of spinal hardware sites with unlisted code 64999. This code is reported only once if multiple hardware injections are performed, such as bilateral injections of spinal hardware at the L4, L5 and S1 spinal levels (AMA, April 2011 and May 2012).

Code: 64999, Unlisted procedure, nervous system
Medicare ASC Reimbursement:None

• Peripheral neurolytic nerve destruction. Report code 64640 for each peripheral neurolytic nerve destruction you perform on a peripheral nerve root. If you perform nerve destruction on the L5, S1, S2 and S3 nerve roots, assign code 64640 x 4 (AMA, June 2012).

Code: 64640, Destruction by neurolytic agent; other peripheral nerve or branch
Medicare ASC Reimbursement:$116.07

Podiatry surgery
• Open metatarsophalangeal joint capsulotomy and hammertoe repair. These are 2 distinct procedures, and it's not unusual for surgeons to perform both procedures during the same session. There is no single CPT code that describes the correction of both conditions, so coders must report the open capsulotomy with code 28270-59 in addition to the hammertoe repair code 28285. Don't assign code 28270 for a percutaneous release of a metatarsophalangeal joint contracture (AMA, September 2011).

Code: 28270, Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)
Medicare ASC Reimbursement:$892.95

• Subtalar joint arthroereisis. Use unlisted CPT code 28899 to report this procedure, which typically involves making an incision over the sinus tarsi and inserting an implant to reposition and stabilize the rear foot, resulting in a decrease in pronatory forces to the foot. You can't code this procedure as an arthrodesis because the intent and result is not fusion of the joint (AMA, September 2011).

Code: 28899, Unlisted procedure, foot or toes
Medicare ASC Reimbursement:None

• Haglund's deformity and retrocalcaneal bursa. Assign code 28118 when you use an osteotome to remove a Haglund's deformity and retrocalcaneal bursa down to the Achilles tendon. The code includes exposure of the Achilles tendon, but you can assign a separate code if you perform debridement of necrotic tissue (28200) on the Achilles tendon (AMA, May 2011).

Code: 28118, Ostectomy, calcaneus;
Medicare ASC Reimbursement:$892.95

Code: 28200, Repair, tendon, flexor, foot; primary or
secondary, without free graft, each tendon
Medicare ASC Reimbursement:$892.95