2022 Updates for Orthopedic Coders
2022 brought several updates to the American Medical Association’s CPT book with the Surgery/Musculoskeletal section receiving a large overhaul. Below, we will be covering those updates related to this system and those commonly used for Orthopedic specialties.
Changes in the Musculoskeletal System section
Below are some of the updates that the Musculoskeletal system section of the CPT book received for this year. We saw revisions and reorganization regarding fracture and dislocation treatment services. These revisions provided clarity when reporting casting, splinting, and traction applications, as well as new definitions and subheadings for manipulation, traction, closed treatment, percutaneous skeletal fixation, along with open treatment and external fixation.
Note: The AMA definition of “closed treatment,” as well as the guidance for the reporting of fracture and/or dislocation treatment codes, which have been added to the Surgery/Musculoskeletal System section of the CPT book.
“Closed treatment”: The treatment site is not surgically opened (i.e., not exposed to the external environment nor directly visualized). Closed treatment of a fracture/dislocation may be performed without manipulation (e.g., application of cast, splint, or strapping), with manipulation, with skeletal traction, and/or with skin traction.
Casting, splinting, or strapping used solely to temporarily stabilize the fracture for patient comfort is not considered closed treatment.
The physician or other qualified healthcare professional providing fracture/dislocation treatment should report the appropriate fracture/dislocation treatment codes for the service he or she provided. If the person providing the initial treatment will not be providing the subsequent treatment, modifier 54 should be appended to the fracture/dislocation treatment codes. If treatment of a fracture as defined above is not performed, report an evaluation and management code.
This update now allows a physician to report a global fracture treatment code when closed treatment without manipulation is performed and no follow-up care will be provided by that physician; in this case, modifier 54 (surgical care only) is added. Previous CPT instructions indicated that in this clinical scenario, the physician would report the appropriate evaluation and management (E/M) code and a code for any splint or cast if applied. There have been discussions between the CPT Editorial Panel and the America Academy of Orthopedic Surgeons regarding this update, with the AAOS strongly apposing this rule. As stated by the AAOS, there should be a thorough review of the ABN from the patient who received fracture care treatment from the ED provider and reimbursement that will follow. The Academy and the CPT Editorial Panel continue to discuss these changes, but it is always recommended to review your specific payor policies when making the final billing decision.
Other minor changes include the deletion of the code for closed treatment of nasal bone fracture without manipulation (21310). Closed treatment of nasal bone fracture codes 21315 and 21320 are revised to include “with manipulation.” Code 21315 is reported when manipulation is performed without stabilization. Report code 21320 is used when the procedure is performed with stabilization. For treatment of closed nasal bone fractures without manipulation or stabilization, CPT guidelines recommend the use of an E/M code to report the service.
It may also come as a relief to orthopedic and neurosurgery coders that new guidelines and definitions have been added to the posterior/posterolateral techniques for spine procedures. Codes 22600-22614 are revised to change “level” to “interspace.” Codes 22633 and 22634 are revised to remove “and segment.” In addition to the code descriptors, this editorial change is made in the parenthetical notes throughout this subsection. Descriptions are added for corpectomy, facetectomy, foraminotomy, hemilaminectomy, laminectomy, and laminotomy.
Definition of Foreign Body Versus Implant
For 2022, the AMA made updates to the Radiology section of the CPT guidelines regarding clarification of foreign bodies versus implants. This text also indicates when an implant can be considered a foreign body for reporting purposes.
“An object intentionally placed by a physician or other qualified healthcare professional for any purpose (e.g., diagnostic or therapeutic) is considered an implant. An object that is unintentionally placed (e.g., trauma or ingestion) is considered a foreign body. If an implant (or part thereof) has moved from its original position or is structurally broken and no longer serves its intended purpose or presents a hazard to the patient, it qualifies as a foreign body for coding purposes, unless CPT coding instructions direct otherwise or a specific CPT code exists to describe the removal of that broken/moved implant.”
Nervous System Surgeries
For code revisions involving the nervous system, AMA made updates to those regarding Laser interstitial thermal therapy (LITT) for treatment of intracranial lesions. This is now reported with two new codes, 61736 and 61737.
Two new add-on codes, +63052 and +63053, report laminectomy, facetectomy, or foraminotomy during a posterior interbody arthrodesis, which can be reported with 22630, 22632, 22633, and 22634.
Note: “Lumbar” is the only portion of the spine indicated as this procedure is only performed on the lumbar spine.
We also saw the deletion of laminectomy codes 63194-63196, 63198, and 63199 and code 63197 was revised to become a parent code, with the deletion of prior parent code 63196.
The description regarding the approach of the implantation of a neurostimulator electrode array codes (64575-64581) have been revised from “incision for” to “open.” You will report hypoglossal nerve stimulator array procedures with three new codes in 2022: 64582-6458; with code 64582 describing the implantation and code 64583 reported for the revision or replacement. You would subsequently report the removal of the electrode as 64584.
Sources:
2021 CPT Codebook (AMA)