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

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med 123

Med 123

Chapter 4.3

Musculoskeletal System

Codes 2000-2999

musculoskeletal section reports

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
guidelines

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
wound exploration 20100 20103

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
excision including biopsies

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
code the following

What about for:

  • Needle or trocar bone marrowbiopsy?
Code the following
introduction or removal 20500 20697

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
fracture and dislocation

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
manipulation and traction

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
coding treatment of fractures and dislocations

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
fracture and dislocation1

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
code the following1

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…
code the following2

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…
spinal procedures to code seperately

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
bunion repairs and casts and strapping

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
arthroscopy

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
hcpcs codes pages 128 129

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
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