By Daniel J. Nagle, MD
Chair, ASSH CPT/RUC Committee
ASSH CPT/RUC Committee Working for You
Five Year Review & New Codes
The ASSH CPT/RUC Committee has reviewed all hand surgery CPT codes in an effort to detect any significant rank order anomalies within the relative values assigned to hand surgery procedures. This task was accomplished using an analysis of the IWPUT (Intra Work Per Unit Time) of each hand surgery code.
In addition to the above analysis, a list of new codes was considered. This list was analyzed within the context of budget neutrality. We do not wish to create new codes without giving serious consideration to the impact such new codes would have on the reimbursement of existing codes. (As you recall, we are working in a “zero sum” game in which the creation of new codes leads to a reduction in the reimbursement for existing codes.) Once a final list was agreed upon, the proposed codes and those to be considered within the five year review were surveyed to provide us with an estimate of the pre, intra and post time needed for each procedure. This was done during the March AAOS meeting. In addition the members of the CPT/RUC Committee completed the surveys to increase the statistical validity of the survey.
The survey indicated that only a few of the procedures being considered should be included in our Five Year Review proposal. (Revaluation of 25620, Open treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid, with or without internal or external fixation is included in the proposal.)These final codes will be resurveyed using the AMA RUC survey tool. The data gleaned from the AMA RUC survey tool will be used as a basis of our proposal to CMS and eventually as the foundation of our presentation to the AMA RUC. (If CMS accepts our proposal we are obliged to defend it before the AMA RUC.)
Leon Benson, MD and his new Code Sub-committee intend to have a proposal for new essential hand surgery codes in the hands of the AMA by November 12, 2004. The new codes will be presented to the CPT Editorial Panel on February 10, 2005. The codes accepted by the CPT Editorial Panel will be defended before the RUC on April 28, 2005. The accepted new codes will become part of the Medicare fee schedule on January 1, 2006. Your cooperation will be needed this winter. You will be asked to complete the AMA RUC surveys on the new codes. Without your help we will not be able to accumulate the data needed to persuade the AMA RUC of the appropriateness of our RVU recommendations.
Multiple Procedure Rule
The fact that many third party payers are ignoring the accepted multiple procedure payment rules prompted Dennis Phelps, MD to ask the CPT/RUC Committee to investigate the history of the multiple procedure rule. This assignment was completed and information explaining the currently accepted multiple procedure coding rules is available to our members. Two letters have also been drafted to assist our members in their efforts to counter inappropriate third party payment policies. Information on multiple procedures is available on the ASSH website.
64718
The resolution of the inappropriate bundling of 24305 (Tendon lengthening, upper arm or elbow, each tendon) with 64718 (Neuroplasty and/or transposition; ulnar nerve at elbow) has entered its final phase. A letter was sent to Administar Federal (the contractor in charge of the CCI edits) outlining the AMA RUC action and requesting the deletion of the 24305 – 64718 edit. I will keep the members of the Society informed as to the outcome of our efforts.
First CMC Arthroplasty
The Committee continues to receive questions regarding the proper coding for first CMC arthroplasty. During the New York City Committee meeting, the following were deemed reasonable methods for coding first CMC arthroplasty. The first two coding techniques, below, could be used for a Burton type arthroplasty in which the first metacarpal is suspended. It was felt the work to accomplish the suspension was similar to that of a tendon transfer. The third technique would be used when the trapezium is removed and replaced with a tendon graft without a reconstruction of the intermetacarpal ligament. Note the use of the -51 modifier with the first two pairs. You will note the total facility RVU is higher for the tendon transfers than for the arthroplasty and therefore, the -51 is applied to 25447 rather than to the tendon transfer. In the third instance no -51 is needed as 20924 is -51 exempt. It was the Committee’s opinion that the tenodesis of the extensor pollicis brevis to the base of the first metacarpal performed with the Burton procedure should not be coded separately.
CMC arthroplasty coding combinations:
25447 – 51 Arthroplasty, interposition, intercarpal or carpometacarpal joints. 26480 Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon.
25447 – 51 Arthroplasty, interposition, intercarpal or carpometacarpal joints. 25310 Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon
25447 - Arthroplasty, interposition, intercarpal or carpometacarpal joints. 20924 Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)
There are no CCI edits prohibiting the 25447 + 26480 or 25310 pairs.
Code Work RVU Total Facility RVU
25447 10.35 20.51
25310 8.13 22.79
26480 6.68 23.37
20924 6.47 13.38
Should you have any questions regarding this Coding Corner please direct them to me or to Dawn Briskey (dbriskey@assh.org) in the Central Office.
Happy coding!
Dan