Med 123

1. Med 123 Chapter 4.3 Musculoskeletal System Codes 2000-2999

2. Surgical procedures on bones, tendons, muscles and soft tissues. • Also included is casting and strapping. • Procedures are listed from head to feet, subheadings for the type of procedure. • Subsections include: • Incision excision • Introduction/removal repair • Fracture/dislocation arthrodesis • amputation Musculoskeletal Section reports

3. Always double-check the subheading to make sure the code is from the same anatomical site. • The extensive notes and definitions before the first code in the subsection should be reviewed before making code selection. • Be careful when using modifier 50. Make sure the procedure notes state bilateral. Guidelines

4. To code traumatic wounds (like gunshot, stab wound) • Codes are based on body area • Codes include: • Surgical exploration • Enlargement of wound • Debridement • Removal of foreign body • Ligation or coagulation of minor vessels Wound Exploration 20100-20103

5. For biopsy of soft tissue choose your code by: • Site, then superficial or deep • Muscle biopsies • 20200, 20205, 20206 • Skin biopsies not coded here – see 11100 • Test your coding skills… • Needle or trocar bone biopsies Excision, Including Biopsies

6. Code selections are… 20220 or 20225

7. What about for: • Needle or trocar bone marrowbiopsy? Code the following

8. Answer is … 38221

9. Introduction would be an injection. • Removal could be by aspiration (look this up) • Code the introduction as one code. • Code the medication agent as a HCPCS code beginning usually with J. • For Removal of wires, pins, screws, rods, and plates: • 20670 is used for removal of superficial hardware. • 20680 is used for removal of implantsthat are considered deep. Deep would be below the muscle or within the bone. Introduction or Removal 20500 – 20697

10. Fractures are either: • Open (requires a incision to be made for treatment) • Closed (does not require a incision for treatment) • Percutaneous (fracture has a device placed across the fracture fragments through the skin) Fracture and Dislocation

11. When the terms reduce or reduction are present in the record to describe the treatment of a fracture a code description of manipulation should be used. • Manipulation is also used to describe the restoration of a fracture or jiont dislocation to it’s normal anatomical alignment using manual force. • Skeletal traction is the application of force to a limb segment through a wire, pin, screw, or clamp is attached to bone. • Skin traction is the application of force to a limb using felt or strapping applied directly to the skin only. Manipulation and Traction

12. Ask the following questions: • What is the site of the fracture or dislocation? • Is treatment open or closed? • Is manipulation a part of the treatment? • Is an internal or external fixation device used? • A cast is not an external fixation device • See page 90 of the professional edition of the CPT for illustration of external fixation devices. Coding treatment of fractures and dislocations

13. Fracture and dislocation treatment codes include: • Application and removal of the initial cast and/or traction device • Follow-up care during the global period associated with the fracture or dislocation treatment code • It does not include: • Plaster or fiberglass supply used to make the cast (See HCPCS Q codes for appropriate code) • Care for complications of the fracture or the fracture site, per the rules of the global surgical package • Use cast removal codes for removal of casts applied by another physician Fracture and Dislocation

14. Open treatment, mandibular fracture w/ external fixation. • Look up fracture, mandible, open, external fixation in alphabetical index, then verify in numerical tabular. Code the following…

15. Answer is… 21454

16. Closed treatment of scapular fracture, without manipulation • Look up fracture, scapula, closed, without manipulation in tabular for your code, then verify in numerical. Code the following…

17. Answer is … 23570

18. Primary repair is the first repair performed. • Secondary repair is done subsequently. Repair and Reconstruction

19. Arthrodesis (fusion) can be coded separately from other definitive procedures • Code seperately: • Spinal instrumentation • Bone grafts • Use modifier –51 • Watch + and  symbols Spinal Procedures to Code seperately

20. Bunion Repairs: • Removal of medial eminence (bump) from first metatarsal head. • Can include revision of the metatarsal shaft, metatarsal head or other surrounding structures. • Casting and Strapping • Casting is used to alleviate pain for the patient • Initial casting when no other treatment is necessary • Initial casting when another physician will provide restorative treatment • Replacement casts are done during follow up care Bunion Repairs and Casts and Strapping

21. Diagnostic arthroscopy (viewing joint by scope) is included in surgical arthroscopy. • If both arthroscopyandarthrotomy (open inspection of joint) are done, code both with a –51 modifier Arthroscopy

22. Orthopedic accessories • For example, slings, splints, rib belts, braces, crutches, and wheelchairs • Custom designed and fabricated orthoses • Cast supplies: • A codes, or • Q codes by type of case and age of patient • See pages 128-129 for more information HCPCS Codes pages 128-129