CPT List
Important Procedure of Ortho
Interview Question : How does we code bone biopsy ?
Bone biopsy is coded based on approach and depth of the bone.
Approach may be needle or may be open.
Depth may be deep and superficial.
20220 Biopsy, bone, trocar, or needle; superficial (eg, ilium,sternum, spinous process, ribs)
20225 Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur)
20240 Biopsy, bone, open; superficial (eg, sternum, spinousprocess, rib, patella, olecranon process, calcaneus, tarsal,metatarsal, carpal, metacarpal, phalanx)
20245 Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft)
20250 Biopsy, vertebral body, open; thoracic
20251 Biopsy, vertebral body, open; lumbar or cervical
Expert Answer: Superficial bone: At the surface, especially on the surface of the skin or immediately below; the opposite of deep.
Related Coding Tips : Distinguish between a bone biopsy and a bone marrow biopsy. For bone biopsy only, use 20220 or use 20225 for a deep bone biopsy of a vertebral body or the femur. If a provider obtains a bone marrow specimen for diagnostic purposes only, use 38221 for biopsy and 38220 for aspiration technique.
Interview Question : What is tendon sheath injection ?
20550 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar “fascia”)
Aponeurosis is an abnormal sheet like extension of the tendon. Injection of a tendon or ligament is the medical therapeutic procedure to reduce the aponeurosis formation.
Injections administered into the tendon sheath or ligament are also called trigger point injections. Trigger points are painful knots in the muscle that form when the muscle fails to relax in cases of exhaustion or injury
Clinical Scenario 1:
Question: What is the correct code for an injection into the wrist compartment for de Quervain disease?
Answer: The provider injects around the tendon sheath when he treats de Quervain disease, so choose 20550. Some coders lean toward 20551, Injections; single tendon origin/insertion, but the injection location around the tendon sheath makes 20550 a better choice.
Interview Question : What is tendon origin injection ?
20551 Injection(s); single tendon origin/insertion
The provider injects a drug into the origin or insertion site of a tendon to relieve pain, inflammation, and swelling from a diseased or damaged tendon.
Corticosteroid: Substance that reduces inflammation.
Tendon insertion: Where a tendon attaches to the bone distally; for example, the insertion site of the quadriceps tendon is the tibial tubercle.
Tendon origin: Where a tendon attaches to the muscle proximally; for example, the origin of the quadriceps tendon is the quadriceps muscle.
Tendon: Fibrous tissue that connects muscles to bones.
Platelet rich plasma: Concentrated fluid consisting of a patient’s own platelets used to accelerate the healing of a damaged tendon
Tips
For single or multiple injections to the same tendon origin or insertion site, report 20551, Injections, single tendon origin or insertion, only one time. For injections to multiple different tendon origin or insertion sites, report this code one time for each injection.
Report code 20551, Injections, single tendon origin or insertion, only for injections into the tendon origin or insertion site and not for an injection directly into a tendon sheath.
Interview Question : How we code trigger point injection for various muscle ?
20552 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)
20553 Injection(s); single or multiple trigger point(s), 3 or more muscles
Tips
Trigger point codes are grouped to reflect the total number of muscles treated, not how many injections the provider performs.
Coding examples include:
A patient presents with neck and shoulder pain. The provider performs six injections on the patient's trapezius muscle and three on the levator scapulae. Report 20552, Injections, single or multiple trigger points, 1 or 2 muscles, because the provider performed TPIs on two muscles.
Interview Question : What is arthrocentesis and how we code them ?
Arthrocentesis is a procedure in which the provider using a needle and a syringe drains or withdraws fluid from the joint.
The code for arthrocentesis is classified on the basic of size of joint and the ultrasound guidance involvement
20600 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance
20604 Arthrocentesis, aspiration and/or injection, small joint orbursa (eg, fingers, toes); with ultrasound guidance
20605 Arthrocentesis, aspiration and/or injection, intermediatejoint or bursa (eg, temporomandibular, acromioclavicular,wrist, elbow or ankle, olecranon bursa); without ultrasound guidance
20605 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular,wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and
reporting
20610 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance
20611 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and
reporting
Interview Question : How do we code for injection on ganglion cyst on wrist ?
A ganglion cyst is an abnormal fluid filled mass, or lump, arising from a tendon or joint, commonly occurring in the hand or wrist but can occur in the foot or ankle
So treatment of ganglion cyst, we have two way either injection of antinflammatory substance of excision of cyst.
20612 Aspiration and/or injection of ganglion cyst(s) any location
25111 Excision of ganglion, wrist (dorsal or volar); primary
25112 Excision of ganglion, wrist (dorsal or volar); recurrent
Interview Question : How do we code for removal of hardware ?
For removal of implant or any part like wire, pins or rod, we code based on the depth the implant is implanted.
20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)
20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)
Tips
Report 20670 for a superficial wound that has a simple closure requiring sutures or adhesive strips. Code 20680, Removal of implant, deep, e.g., buried wire, pin, screw, metal band, nail, rod or plate, typically involves going down through muscle layers and into the bone and requires a more complex, layered closure.
A provider performs two hardware removals on the same body part on the same day, but he performed them through separate incisions. According to the American Academy of Orthopaedic Surgeons, you should report 20680 regardless of how many screws the provider removed.
Interview Question : What is skeletal fixation system ?
Skeletal Fixation system are the fixation system that is used to support the skeletal deformity or fracture. These system are classify based on uniplane or Multiplane.
Also, it may be internal fixation or external fixation. Uniplanar pin systems are used almost exclusively for shaft fractures, especially midshaft tibia, or shinbone, fractures.
20690 Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation system
20692 Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)
20694 Removal, under anesthesia, of external fixation system
Tips
The provider applies a uniplane external fixation on one side of the body. Uniplane fixators use thicker, more solid pins for fixation than multiplane fixators. Ring fixator pins are much narrower, and the surgeon places them under tension. If you see the term thin wire, or thin pin, or see a description of tensioning the pins, this is almost certainly a ring, or multiplane, fixator.
Common external fixator devices include Kirschner wires, Schanz screws, and Steinman pins.
Interview Question : How do we code for bone graft ?
Bone grafting is a Surgical procedure that replaces missing bones with material from the patient's own body, or from an artificial, synthetic, or natural substitute.
20900 Bone graft, any donor area; minor or small (eg, dowel or button)
20902 Bone graft, any donor area; major or large
Tips
Report separately codes for obtaining autogenous grafts, which are grafts harvested from a patient’s own body, through separate skin or fascial incisions, unless the code descriptor references the harvesting of the graft or implant, e.g., stating that it includes obtaining graft.
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Interview Question : How do we code for Excision of soft tissue tumor ?
A soft tissue tumor is a tumor that can be benign or malignant and develop in the soft tissues of the body, such as muscles, organs, and blood vessels.
Common soft tissue benign tumor is Lipoma.
Common Malignant soft tissue tumors, is sarcoma.
The code selection is based on:
-
The depth of the tumor such as subcutaneous, subfascial.
-
Size of the tumor
-
Radical resection of the tumor for sacroma
21011 Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm
21012 Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater
21013 Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm
21014 Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greater
21015 Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cm
21016 Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; 2 cm or greater
Tips
This code is for radical resection of tumors of musculoskeletal origin, such as a sarcoma. Wide margins of excision beyond the tumor dimensions are necessary to report this code.
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Interview Question : How do we code manipulation of temporamandibular joints ?
21073 Manipulation of temporomandibular joint(s) (TMJ),therapeutic, requiring an anesthesia service (ie, general ormonitored anesthesia care)
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Interview Question : How do we code for Nasal bone fracture along with nasal septum ?
Nasal bone is the small flat bone of the skull.
Nasal septum: Thin wall that divides the inside of the nose into left and right nostrils; it is composed of cartilage and bone.
Splint is the stabilization device.
The code selection is based on:
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The approach which may be open or closed.
-
Stablization device such as Splint
Tips: We can code for both the nasal fracture and septum with appropriated modifier.
20315 Closed treatment of nasal bone fracture with manipulation; without stabilization
21320 Closed treatment of nasal bone fracture with manipulation; with stabilization
21325 Open treatment of nasal fracture; uncomplicated
21330 Open treatment of nasal fracture; complicated, with internal and/or external skeletal
fixation
21335 Open treatment of nasal fracture; with concomitant open treatment of fractured septum
21336 Open treatment of nasal septal fracture, with or without stabilization
21337 Closed treatment of nasal septal fracture, with or without stabilization
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Interview Question : How do we code spinal fusion or arthrodesis ?
Spinal fusion is the fusion of spinal verterbrae.
So code selection is based on many :
Approach : Anterior / Posterior or combined.
Graft used : This is coded separtely which may be Allograft or Autograft.
Instrumentation : Instrumentation are the hardware that is used to join the spinal verterbrae, it may be anterior or posterior and based on number of segment.
Tips : When arthrodesis is performed in addition to another procedure, the arthrodesis should be reported in addition to the original procedure
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Interview Question : What is shoulder arthroplasty?
Shoulder arthroplasty is the shoulder replacement surgery where damage part of shoulder are replaced with porosthesis. The medical necessity of arthoplasty is osteoarthritis.
Interview Question : What is hemi shoulder arthroplasty?
In this procedure, the provider performs glenohumeral joint hemiarthroplasty in which the provider replaces the damaged head of a humerus with a prosthetic implant while the other half of the shoulder, the glenoid cavity is left intact.
Glenoid cavity: A hollow socket in the shoulder blade, which articulates with the humeral head to form the shoulder joint.
Glenohumeral joint: A synovial ball and socket joint between the head of the humerus and the glenoid cavity of the shoulder blade, also known as the shoulder joint.
Prosthesis: An artificial device that replaces a body part.
23470 Arthroplasty, glenohumeral joint; hemiarthroplasty
Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises across the front of the shoulder from the middle of the collarbone to the middle of the arm bone. The provider continues to dissect down through subcutaneous tissue, or just under the skin, to access the joint. Next, he retracts the muscles, nerves, and blood vessels. He then incises the joint capsule and dislocates the glenohumeral joint to dislodge the head of humerus from the glenoid socket. He then removes all the loose bodies present in the cavity. Next, he incises the damaged head of the humerus using an osteotome and places a prosthetic humeral head implant stem into the humerus shaft by drilling into the medullary canal. Next, he places the prosthetic humerus head into correct alignment and reduces it into the glenoid cavity. He sutures the muscle around the joint to provide the appropriate stabilization. He removes all the osteophytes around the joint. Finally, he stops all bleeding, places drains, and closes the wound by suturing the layers of tissue. He then places the shoulder in a brace or sling for a period of four to six weeks to help with healing.
Interview Question : What is total shoulder arthroplasty?
In this procedure, the provider performs a total shoulder arthroplasty in which the provider replaces the damaged head of the humerus and the glenoid cavity with prosthetic implants.
Acromioplasty: Removal of part of the acromion bone, the bony projection of the shoulder blade that forms the point of the shoulder.
Glenoid cavity: A hollow socket in the shoulder blade, which articulates with the humeral head to form the shoulder joint.
Glenohumeral joint: A synovial ball and socket joint between the head of the humerus and the glenoid cavity of the shoulder blade, also known as the shoulder joint.
Prosthesis: An artificial device that replaces a body part.
23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)
Clinical Responsibility : Clinical Responsibility
When the patient is appropriately prepped and anesthetized, the provider incises across the front of the shoulder from the middle of the collarbone to the middle of the arm bone. The provider continues to dissect down through the subcutaneous tissue, or just under the skin, to access the joint. Next, he retracts the muscles, nerves, and blood vessels. He then incises the joint capsule and dislocates the glenohumeral joint to dislodge the head of the humerus from the glenoid socket. He then removes all the loose bodies present in the cavity.
Next, he prepares the glenoid cavity for the artificial implant. He removes the articular cartilage from the glenoid cavity and uses a surgical instrument to shape it to receive the artificial glenoid component. He next fills the glenoid socket with bone cement and places the artificial glenoid component into place. He then incises the damaged head of the humerus using an osteotome and places a prosthetic humeral head implant stem into the humerus shaft by drilling into the medullary canal. Next, he places the prosthetic humerus head into correct alignment and reduces it into the glenoid component. He may also perform acromioplasty to decompress the soft tissue structures. He then sutures the muscles around the joint to provide the appropriate stabilization. He removes all the osteophytes around the joint. Finally, he stops all bleeding, places drains, and closes the wound by suturing the layers of tissue together. He then places the shoulder in a brace or sling for a period of four to six weeks to help with healing.
Interview Question : Which is the revision of total shoulder arthroplasty ?
In this procedure, the provider performs a revision arthroplasty of the shoulder joint, or he removes a previous artificial shoulder joint implant, or prosthesis, and replaces it with a new prosthesis. He revises either the glenoid or humeral component. He may use an allograft to perform this procedure. The provider performs this procedure to remove a loose or damaged prosthesis before it does irreversible harm to the joint
23473 Revision of total shoulder arthroplasty, including allograftwhen performed; humeral or glenoid component
23474 Revision of total shoulder arthroplasty, including allograftwhen performed; humeral and glenoid component
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Interview Question : How do we code for surgical treatment of Quervains disease?
The provider makes an incision into the wrist’s extensor tendon sheath to release the contracture of the tendon.
De Quervain's disease: A painful inflammation of thumb tendons that extend to the wrist.
Joint contracture: The permanent tightening of non–bony tissues, such as muscles, tendons, or ligaments of the joint.
25000 Incision, extensor tendon sheath, wrist (eg, de Quervains disease)
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Interview Question : What is the treatment of Si joint dysfunction ?
A Sacroiliac joint dysfunction is the pain in the sacroiliac joint or limitation of movement of sacroiliac joint.
https://www.spine-health.com/video/sacroiliac-joint-dysfunction-video
27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed
The provider performs an injection in the joint between the sacrum and ilium on one side of the body, with the aid of imaging equipment to locate the injection site. He injects an anesthetic to relieve pain and or a corticosteroid, a powerful antiinflammatory medication.
Tips
Code 27096 is to be used only with CT or fluoroscopic imaging confirmation of intraarticular needle positioning. If CT or fluoroscopy imaging is not performed, use 20552, Injections, single or multiple trigger points, 1 or 2 muscles.
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Interview Question : What is Hip arthroplasty?
Shoulder arthro
27125 Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)
27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft.
27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft.
27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft
27137 Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft
27138 Revision of total hip arthroplasty; femoral component only, with or without allograft
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Interview Question : What is Hip arthroplasty?
Shoulder arthro
27445 Arthroplasty, knee, hinge prosthesis (eg, Walldius type)
27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment
27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)
27486 Revision of total knee arthroplasty, with or without allograft; 1 component
27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component
27488 Removal of prosthesis, including total knee prosthesis,methylmethacrylate with or without insertion of spacer,knee