CPT Coding Hand and Extremity Surgery
10/11/2012
CPT? Coding
for Hand and
Upper Extremity Surgery
Taizoon H Baxamusa, MD, FACS
Hand Upper Extremity,
Hand,
Extremity & Microvascular Surgery
The Illinois Bone & Joint Institute
Morton Grove, IL
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
Orthopaedic Hand & Upper Extremity &
Microvascular Surgery
?
?
?
?
?
Yale University©\
y Orthopaedic
p
Surgery
g y
The Indiana Hand Center
The American Academy of Orthopaedic Surgeons
The American Society for Surgery of the Hand
The Chicago Society for Surgery of the Hand
? Disclaimer
Disclaimer¡This
This is my own personal experience and not an
official party line of the groups above.
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
1
10/11/2012
Coding & Hand Surgery
?Devaluation of Hand Surgery codes within
O th
Orthopaedic
di Surgery
S
?Complex variety of upper extremity
procedures
?Variability in interpretation of procedures
?Case Examples
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
Devaluation of Hand Surgery
? ¡°Big Joints¡± pay more than ¡°small joints¡±
? Spine>>Sports>Hand/Foot
S i
S t H d/F t A
Ankle
kl
? RVU of IT Hip fx (intern¡¯s procedure) is valued equal
to Scaphoid fracture (complex hand referral from
fellow orthopaedists)
? Important to accurately code for work performed
and
d be
b reimbursed
i b
d within
i hi proper C
Correct Coding
C di
Inititiatives
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
2
10/11/2012
HCFA¡¯s ¡°Budget Neutrality¡±
? The total RVU¡¯s attributed to the new and existing
codes in a family cannot increase.
¨C ¡°Zero Sum Game¡±
? The total RVU¡¯s for the specialty would be distributed
among the codes (old & new)
? Attempt to maintain bundling of similar services
? Exception=
p
new codes that describe new technology
gy
(ie arthroscopy, nerve conduits, etc)
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
Hand Surgery vs. Orthopaedics
? More than just
attention to X©\Ray
X Ray
? Soft tissue management
often core problem for
complications
? Soft tissues often
influence function and
final ROM
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
3
10/11/2012
Complexity of Injury
?Skin
?Tendon
?Nerve
?Artery
?Bone
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
Complex Variety of Hand Procedures
? Dozens of different variations of common
procedures:
¨C Basal Joint Arthroplasty
? LRTI, Suspension, Scope, Anchovy, etc.
¨C Thumb Opponensplasty
? Huber,
Huber Camitz
Camitz, Brand©\Stiles,
Brand Stiles etc
etc.
¨C Lateral Epicondylitis
? Nirschl, Jobe, scope, etc.
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
4
10/11/2012
Complexity of Hand Anatomy
?Nomenclature of Bones,
Joints etc
Joints,
¨C P1/P2/P3, MC
¨C PIP/DIP/MCP,
RDN,FDP,FDS,EDC
?Distinct diagnoses that
should remain
individualized and not
bundled
Carpal Tunnel
American Academy of
Professional Coders
Session 1A, 10-11:30
AM Friday, October
26th, 2012
Hand Skeletal Anatomy
?PHALANGES
¨C Proximal
¨C Middle (exc. Thumb)
¨C Distal
?METACARPALS
?CARPAL BONES
¨C Scaphoid
Scaphoid, Lunate,
Lunate Triquetrum,
Triquetrum
Pisiform, Trapezium,
Trapezoid, Capitate, Hamate
Session 1A, 10-11:30
AM Friday, October
26th, 2012
American Academy of
Professional Coders
5
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