Scope it Out! Arthroscopic Procedures

Scope it Out!

Arthroscopic Procedures

Julie

Ju

e A. Leu,

eu, C

CPC,

C, C

CPCO,

CO, C

CPMA,,

CPC-I

2009-2011 NAB Member, Region 7

Disclaimer

Every reasonable effort has been made to ensure that

the educational material provided today is accurate and

useful. No warranty, either express or implied, is made

regarding the content of this presentation, due to

constantly changing regulations and differing payer

policies.

All CPT? codes,

d

descriptions,

d

i ti

and

d two-digit

t

di it modifiers,

difi

copyright 2010 American Medical Association. All rights

reserved.

?1

Topics

?

?

?

?

?

?

?

?

Correct Coding Concepts

Historyy of Arthroscopic

p Procedures

Anatomy of the Shoulder Joint

Shoulder Pathology

Arthroscopic Procedures on the Shoulder

Anatomy of the Knee Joint

Knee Pathology

Arthroscopic Procedures on the Knee

Correct Coding Concepts

? Surgical Package Concept

¨C CPT? definition

¨C CMS ¨C NCCI

¨C AAOS Global Service Data

? Separate Procedures

? Diagnostic vs. Therapeutic Procedures

? Arthroscopic vs. Open Procedures

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CPT? Surgical Package Definition

? Local infiltration, metacarpal/metatarsal/digital

block or topical anesthesia

? Subsequent to the decision for surgery

surgery, one

related E/M encounter on the date immediately

prior to or on the date of procedure (including

history and physical)

? Immediate postoperative care, including dictating

operative notes, talking with the family and other

physicians

? Writing

W iti orders

d

? Evaluating the patient in the post-anesthesia

recovery area

? Typical postoperative follow-up care

CMS Surgical Package

? All procedures on the Medicare Physician Fee

Schedule are assigned a Global period of 000,

010 090

010,

090, XXX

XXX, YYY

YYY, or ZZZ

ZZZ.

? Procedures with zero or ten day global period

are considered minor.

? Procedures with a 90 day global period are

considered major procedures.

¨C Decision for surgery

g y E/M is separately

p

yp

payable

y

? Follow-up care, including treatment for

complications, is not separately payable, unless

it requires a return to the operating room.

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CPT? vs. CMS

? Major procedures

include

c ude 90 days post

post-op

op

? Global

Gl b l package

k

concept, but no defined ? Minor procedures

include 0 or 10 days

number of days

post-op

? ¡°Typical¡± postoperative ? Follow-up care includes

follow-up care

pain management and

care for complications,

unless they require a

return to the operating

room

AAOS Global Service Data Guide

? American Academy of Orthopaedic

Surgeons

¨C Coding, Coverage, and Reimbursement

Committee

¨C Includes procedures commonly performed by

Orthopaedic surgeons

¨C Lists the services which are included and

which are excluded for each procedure

¨C Available electronically through vendors

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Separate Procedure Designation

? Per CPT?, procedures or services that are

commonly carried out as an integral component

off a total service or procedure.

? When carried out independently or considered to

be unrelated or distinct from other

procedures/services provided at that time, it may

be reported by itself, or in addition to other

proced res/ser ices

procedures/services.

? 29870 Arthroscopy, knee, diagnostic; with or

without synovial biopsy (separate procedure)

Separate Procedure Designation

? Per NCCI, If a CPT code descriptor includes the

term ¡°separate procedure¡±, the CPT code may not

be reported separately with a related procedure

procedure.

CMS interprets this designation to prohibit the

separate reporting of a ¡°separate procedure¡± when

performed with another procedure in an

anatomically related region often through the

same skin incision, orifice, or surgical approach.

? Modifier 59 or a more specific modifier (e.g.,

anatomic

t i modifier)

difi ) may b

be appended

d d tto th

the

¡°separate procedure¡± CPT code to indicate that it

qualifies as a separately reportable service.

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