Scope it Out! Arthroscopic Procedures
嚜燙cope 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
每 CPT? definition
每 CMS 每 NCCI
每 AAOS Global Service Data
? Separate Procedures
? Diagnostic vs. Therapeutic Procedures
? Arthroscopic vs. Open Procedures
?2
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.
每 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.
?3
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
每 Coding, Coverage, and Reimbursement
Committee
每 Includes procedures commonly performed by
Orthopaedic surgeons
每 Lists the services which are included and
which are excluded for each procedure
每 Available electronically through vendors
?4
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.
?5
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